The vaccine
controversy
By Tania Haas
ixty years ago an average of 400 Canadians contracted polio per year. Those who
survived were left with a paralyzed nervous
system and permanently maimed limbs.
Today, polio is prevalent in only a handful of countries
and eradicated in Canada thanks to routine immunizations against it and 12 other potentially fatal conditions. Along with flush toilets and clean water, routine
immunizations, or vaccines, are considered the world’s
most important defence against preventable diseases.

S

Surprisingly, while vaccines are free and readily
available in Canada, cases of infectious diseases,
like measles and pertussis (also called whooping cough), are on the rise. The resurgence is a
result of Canada’s falling child vaccination rates –
resulting from parental complacency and hesitancy,
widespread misinformation, socioeconomic factors,
cultural miscommunication, a fragmented national
strategy and passive public health efforts.
Continued on page 14

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PAIN CONTROL/COMPLEMENTARY HEALTH/HEALTH PROMOTION

Focus

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A new report, System Performance Special Focus Report: Examining Disparities in
Cancer Control, uncovers potentially important disparities in the cancer care received by Canadians based on how much
they earn, where they live, and if they
are recent immigrants or Canadian-born.
Led by the Canadian Partnership Against
Cancer, the report shows that people from
the poorest urban neighbourhoods are less
likely to survive cancer compared with urban residents from the richest neighbourhoods and that this might be related to
inequities in access to diagnosis and treatment services.
The new report shows that the wealthiest urban residents have a 73-per-cent
chance of surviving their cancers five
years after a diagnosis (relative to others
in the general population of their age, sex
and income level) compared with 61-percent for people living in the poorest urban
neighbourhoods.
Earlier research has established that,
with higher rates of smoking and obesity,
lower income and rural Canadians have
a greater risk of getting some cancers and
dying from them. However, gaps in survival tend to reflect differences in diagnosis
and treatment as opposed to differences in
the risk of getting cancer. In this context,
the report reveals for the first time at a
pan-Canadian level that people living in
lower income and rural and remote communities may not be accessing the best
cancer care as compared to their wealthier
urban neighbours. For example, although
finding cancers early can often offer a better chance of surviving the disease, the report's results suggest that Canadians from
lower income households are less likely
to report being screened for cancer than
those from higher-income households.
The report provides indicators that suggest that across the diagnosis and treatment pathway from screening and early
detection, to radiation therapy, surgery,
and enrolment in clinical trials – at every
step of the cancer-care journey, these lower income and more rural-dwelling segments of the Canadian population could
H
be falling behind. ■

The Canadian Medical Association
(CMA) will be travelling across the
country over the next three months to
find out what Canadians think about
end-of-life issues in a national dialogue.
The first of five town hall was held in
St. John's, Nfld., in February. Dr. Louis
Hugo Francescutti, CMA President,
says the goal is to engage and hear Canadians' thoughts on physician-assisted
dying, palliative care and advance care

3

to sound out Canadians
on end-of-life issues
planning. "Most of the attention has
been focused on the question of physician-assisted dying and we're concerned
the end-of-life debate is being oversimplified. We need to hear more from Canadians about how their health care system can ensure not only a long, healthy
life but also a good death.'' In addition
to the town hall meeting in St. John's
the other public town halls, in association with the Canadian Society of Pallia-

tive Care Physicians and the Canadian
Hospice Palliative Care Association,
will be held in:
• Vancouver, March 24
• Whitehorse, April 16
• Regina, May 7
• Mississauga, May 27
Following the town halls, the CMA
will release a summary report on how the
public views end-of-life issues to provide
H
guidance in future policy decisions. ■

Antidepressant holds promise
in treating Alzheimer's agitation
An antidepressant medication has
shown potential in treating symptoms of
agitation that occur with Alzheimer's disease and in alleviating caregivers' stress,
according to a multi-site U.S.-Canada
study. "Up to 90 per cent of people with
dementia experience symptoms of agitation such as emotional distress, restlessness, aggression or irritability, which is
upsetting for patients and places a huge
burden on their caregivers," says Dr. Bruce
G. Pollock, Vice President of Research
at the Centre for Addiction and Mental
Health (CAMH), who directed research
at the CAMH site. "These symptoms are a
major reason why people go into long-term
care prematurely."
The antidepressant citalopram, sold under the brand names Celexa and Cipramil,
significantly relieved agitation in a group
of Alzheimer's disease (AD) patients as
reported in the February 19 issue of the
Journal of the American Medical Association.
"When agitation occurs, it's paramount
to try non-medication approaches first,
such as looking for underlying physical
discomfort in a patient, reducing external
triggers such as noise or overstimulation,
and encouraging light exercise," says Dr.
Pollock, Director of CAMH's Campbell
Family Mental Health Research Institute.
When these approaches don't work, anti-

psychotic medications are commonly used
to treat agitation. "Antipsychotics are not
an ideal therapy and significantly increase
the risk of strokes, heart attacks and sudden death," he adds.
Based on promising early findings from
Europe, Dr. Pollock began conducting
studies on citalopram, which suggested it

might be a viable treatment alternative
to antipsychotics. To provide stronger
evidence, the Citalopram for Agitation in
Alzheimer's Disease Study (CitAD) was
initiated with eight leading Alzheimer's
research centres across the United States
and Canada, including the Geriatric ProH
gram at CAMH. ■

Safety concerns with new drugs
A York University study of drug safety
shows that new drugs are often on the
market in Canada for more than three
years before they are withdrawn as unsafe, raising concerns about turning to the
newest drugs available. The study by Joel
Lexchin, an emergency room physician
and professor of the School of Healthy
Policy and Management in York’s Faculty
of Health was published in Open Medicine. “As a doctor my policy is not to prescribe new drugs until they have been on
the market for at least three or four years
since I don’t know how safe they will be
for my patients,” says Lexchin. “Based on
the findings in this study, doctors should
not prescribe drugs during this period and
patients should not take them, unless
they are substantially better than existing

medications.” Lexchin found that 4.2 per
cent of the 528 new drugs approved in
Canada in a 20-year period (Jan. 1, 1990
to Dec. 31, 2009) were later withdrawn.
Of the 22 drugs withdrawn, 11 first had
a serious safety warning and 11 did not.
The median time between approval and
withdrawal was almost three-and-a-half
years. The study examined four 5-year
periods and found no difference in the
percentage of approved drugs that were
eventually withdrawn from the market.
This shows that the drug review system’s
ability to detect serious safety issues and
keep those drugs off the market did not
change over the 20-year period, he says,
but also raises questions about the rigour
of the surveillance system once drugs are
H
on the market. ■

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Vaccines are safe
– time to communicate it
Being a parent is hard – probably
the most difficult job those of us with
children will ever have. Don’t get me
wrong, it’s also one of the best jobs –
but it doesn’t come easy.
Should you formula or breast-feed?
Use cloth or disposable diapers? The
questions are never-ending. In the
early sleep-deprived days it’s astounding that new parents are able to make
decisions on the most trivial of parenting issues – let alone deciding on
whether or not to vaccinate their new
baby.
Regardless of opinions on feeding,
diapering, sleeping, schooling – one
thing most parents have in common is
that we want the best for our children
and will do anything we can to keep
them safe.
Prior to becoming a mom I didn’t
give vaccination a second-thought.
I accepted and supported that vaccinations protect humans from terrible,
highly infectious, potentially fatal diseases. I was vaccinated. Without question, my children would be too.
Then I actually became a mom.
And people aren’t lying when they
say that changes everything. I had a
new purpose and it was to protect this
amazing little human from everything
I possibly could. It’s a tremendous responsibility – one that comes with a
lot of pressure and second-guessing.
We are fortunate that we live in
an information age – basically anything we want to know is just a few
keystrokes away. We can educate ourselves on any topic, find a wealth of
parenting advice and even join forums
to discuss issues with other parents.
Before bringing my baby to receive the
first round of vaccinations I looked up
possible side-effects and what to look
for to detect adverse reactions.
There is some terrifying information about vaccinations online. It’s no
wonder the anti-vaccination movement has made such headway. Being

a strong supporter of vaccination, it
wasn’t hard for me to research and
find credible information refuting the
wealth of misinformation and reasons
I shouldn’t vaccinate my baby. But I
can completely understand how some
parents buy into it.
Back in 2011 I penned a column
entitled “Immunization is not a bad
word.” Not surprisingly, I received a
lot of feedback. One letter I received
from a family physician in Ontario was
quite disheartening. In the column I
stressed the role health care professionals have in educating parents and
dispelling the myths about the dangers
of vaccination. This family physician
disagreed and believed it was not his
job to educate parents saying he did
not have time to spend with parents
– they should be able to sort through
what is reliable information and what
is not.
If it’s not the job of our doctor to
help us make decisions about our
health, and the health of our children
then whose job is it? In many aspects
of healthcare patients are expected
and encouraged to actively participate
and manage their own care – if we
want engaged and informed patients
we can’t then turn our backs when
they have questions about information they found online – no matter
how misinformed. Who can blame a
parent for seeking out information
when their own doctor is not able or
too busy to provide them with the information?
Recently, Public Health Ontario
released a first-of-its-kind comprehensive assessment of vaccine safety in
Ontario. The report aims to encourage ongoing assessment of vaccine
safety and provide relevant and timely
information for health professionals
and the public about the safety of vaccines administered in Ontario.
In 2012 approximately 7.8 million
publicly funded vaccine doses were

Kristie Jones, Editor

ADVISORY BOARD
Jonathan E. Prousky,

BPHE, B.SC., N.D., FRSH
Chief Naturopathic Medical Officer
The Canadian College Of Naturopathic
Medicine
North York, ON

distributed in Ontario. Of those, only
631 adverse events following vaccinations were reported. Of the 631 adverse events reported, most were mild.
Only 56 serious events were reported
– which represents 7.2 in every million
doses distributed. Serious events after
vaccines are extremely rare.
Are there risks associated with vaccines? Of course. There are risks associated with leaving your house in the
morning. There are risks with every
single medical procedure. It’s about
weighing the risks and benefits. Many
scientific studies have demonstrated
that the benefits of vaccines far outweigh the risks. Not one death was
reported as a result of the 7.8 million
vaccines distributed in Ontario. Not
one. The same can’t be said for the
diseases these vaccines prevent.
Many experts are warning Canada’s
falling vaccination rates could lead to
a public health crisis as once nearly
eradicated diseases are reappearing.
This month Hospital News takes an in
depth look at the vaccine controversy
in our cover story that examines why
vaccination rates are falling and what
can be done about it. Hospital News
ethicist provides an ethical analysis of
a new and disturbing trend among pediatricians – discharging patients who
refuse to immunize their children. On
page 16 we provide a brief history of
vaccines and Canadian innovation
with highlights from an exhibit on display at the Museum of Health Care.
Vaccination is arguably the most effective health promotion tool we have
in our arsenal. While the report on adverse events in Ontario is a good start,
this information needs to be communicated to patients through their
health care professional. We need
to work harder to dispel the myths
of the dangers of vaccines and it is
most definitely the job of our doctors
and health professionals to educate
H
their patients. ■

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PAIN CONTROL/COMPLEMENTARY HEALTH/HEALTH PROMOTION

www.hospitalnews.com

Focus

5

MARCH 2014 HOSPITAL NEWS

6

Evidence Matters

Side effects of anti-inflammatory drugs:

What’s the evidence?
By Sarah Jennings
raditional non-steroidal antiinflammatory drugs (NSAIDs)
include ibuprofen (Advil,
Motrin), diclofenac (Voltaren), naproxen (Naprosyn), and others.
These drugs are widely available in many
dosage forms and most hospitals have several on formulary. NSAIDs are first-line
options for many types of pain, but they
can cause stomach upset and occasionally
gastrointestinal (GI) bleeding.
When cyclooxygenase-2 (COX-2) inhibitors such as celecoxib (Celebrex) became
available, they were expected to cause less
GI bleeding. Some studies did indeed show
less GI bleeding, but some didn’t – and
then some studies showed an increased
risk of cardiovascular events such as heart
attacks and strokes. The COX-2 inhibitor
rofecoxib (Vioxx) was removed from the
Canadian market in 2004 for this reason.
Several conflicting studies led to a COX-2
controversy. Were they safe?
Then studies began to emerge showing that traditional NSAIDs might carry
cardiovascular risk as well. How big is this
risk? Is it the same for all NSAIDs? With
so much conflicting data, what information can a clinician trust, and which drugs
should hospitals have on hand for treating
mild to moderate pain?

T

Systematic reviews
This situation demonstrates the value
of a systematic review. Systematic reviews
of the medical literature capture all studies available on a given topic. As more
studies become available on a given topic,
we can have more confidence when we see
conclusions repeated, or when a more
mature data set is presented in one
paper with a critical appraisal of all the
included studies.
When the design of the studies is similar, the data from different studies can be
pooled and re-analyzed together; this is
called a meta-analysis. With more data
comes more power to detect differences
between treatments or to identify rare
side effects.

The hierarchy of evidence
For all these reasons, systematic review and meta-analysis sit at the top of
the “hierarchy of evidence.” This hierarchy is a way of ranking different types
of clinical studies. In general, systematic
reviews and meta-analyses are more reliable than a single randomized controlled
trial (RCT), which in turn is more reliable than non-randomized studies such
as cohort studies and case reports. Quality is important, though; a well-done

study at the bottom of the hierarchy may
be more reliable than a poorly-done systematic review.
Hallmarks of a high-quality systematic
review include: a clearly formulated research question, a structured literature
search strategy that others can reproduce, explicit methods for selecting and
critically appraising studies, and a clear
reproducible description of the methods
used to analyze the data.

CADTH evidence review
CADTH recently critically appraised
six systematic reviews and meta-analyses on COX-2 and NSAID safety. Two
systematic reviews of RCTs reported no
differences in cardiovascular or GI outcomes between celecoxib and high dose
diclofenac, but one systematic review
of non-randomized studies reported a
slightly higher cardiovascular risk with
diclofenac. For celecoxib vs. ibuprofen,
celecoxib was associated with fewer GI
complications without any statistically
significant differences in major cardiovascular events. For celecoxib vs. naproxen, the risk of cardiovascular events was
higher with celecoxib, but there were
more GI complications with naproxen.
The bottom line is that:

• naproxen seems to have lower cardiovascular risk than celecoxib
• diclofenac and ibuprofen seem to have
the same cardiovascular risk as celecoxib
•celecoxib and diclofenac seem to
have lower GI risk than ibuprofen and
naproxen
• clinicians may need to beware of
underestimating the risks of these drugs
These results show the value of using
systematic reviews, not only for controversial drugs such as COX-2 inhibitors,
but also for commonly used drugs such as
NSAIDs.
It’s also important to remember that
a systematic review has the same limitations as the studies feeding into it.
For example, most of the studies in these
reviews lasted for three months or less,
so by extension, the systematic reviews
can only answer questions about shortterm use. Systematic reviews and metaanalyses have more power and precision than individual clinical trials, but
their quality and relevance will always
depend on the quality and relevance of
H
the original studies. ■
Sarah Jennings, PharmD,
is a Knowledge Mobilization
Officer at CADTH.

hen you think about relieving the aches and pains in
your muscles and joints, the
last thing most people want is

surgery.
The thought of being on an operating
table is the exact reason Toronto resident
George Danylkiw avoided surgery on his
shoulder for so long – even though it was
filled with pain. “Over the last year or so,
the pain became so bad, I couldn’t sleep at
night, sitting down was painful and moving
my arm above my head was impossible,” he
recalls.
But thanks to an innovative approach
to the positioning which facilitates arthroscopic shoulder surgery, developed
by Dr. Amr Elmaraghy, an upper extremity Orthopaedic surgeon at St. Joseph’s
Health Centre (St. Joe’s), Danylkiw knew
he could overcome his apprehension to
surgery for the benefit of his health.
Arthroscopic shoulder surgery techniques are less invasive than the traditional open surgery method, and uses a tiny
camera called an arthroscope and various
instruments to repair the tissues inside or
around the shoulder joint. The camera and
tools are inserted through small incisions
in the skin. In Danylkiw’s case, surgery
was needed to remove a bone spur and
repair the rotator cuff tendons in his
right shoulder.
To enhance the procedure in a way that
benefits both himself as a surgeon and patients like Danylkiw, Dr. Elmaraghy sits his
patients up in the “beach chair” position
during the surgery – then applies traction
and leverage to their arm to open up spaces within the shoulder. This innovative approach to creating space makes it easier to
use the necessary hand and power tools to
repair damage in the shoulder, while ensuring that no additional damage is done to
the surrounding cartilage and tissue.
Two months after surgery George says he
www.hospitalnews.com

feels “like a million bucks”. The only proof
of his surgery are the five tiny marks left
from the incisions made by Dr. Elmaraghy
to repair his rotator cuff. His shoulder pain
is completely gone.
Danylkiw believes his shoulder pain is
a result from his days as a body builder.
“Body building is great for you but if you
don’t do it correctly it causes more damage
than good,” he says.
As a young adult he was also dedicated
to weight training and gymnastics. Today
at 68 years old, he’s a semi-retired contractor who still loves to stay active especially
through cross country bicycling and several cycling accidents over the last two years
have also taken a toll on his shoulders.
A number of MRI scans revealed extensive damage to Danylkiw’s shoulder –
a bone spur and rotator cuff tears - which
were causing him so much pain. He tried
everything short of surgery to relieve the
pain – physical therapy, cortisone shots,
and medication – but nothing helped, explains Dr. Elmaraghy, who initially met Danylkiw five years ago.
Sleepless nights, constant pain and the
inability to lift his arm properly left Danylkiw with one more choice – surgery.
“Beach Chair Traction positioning is an
innovation that’s really behind the scenes,
meaning patients may not realize the benefit of this technique, to open up spaces
while (clinicians are) doing the procedures
– but they will see the results,” says Dr. Elmaraghy. “What this means for patients is
a surgery that is quicker, safer and more efficient, allowing them to get back to their
day-to-day life and be pain free, and to do
those sporting activities with better function and range of motion.”
All surgeons face the need to work
within spaces that don’t normally exist,
especially around the shoulder joint and
shoulder tendons, Dr. Elmaraghy explains.
“Your assistants (in the operating room)

can’t provide that kind of holding force
throughout the entire length of the procedure that is stable, predictable and effective as far as opening up space around
cartilage and tendons. So that was the
need that I faced and the beach chair traction positioning method was the solution I
came up with,” he says.
When Danylkiw first heard of Dr. Elmaraghy’s approach to arthroscopic surgery
he was excited to benefit from this approach and finally find the right solution to
relieve his pain. He was even more thank-

ful to receive this level of innovative care
close to home at his local hospital.
“I really believe that innovation is the
wave of future for everything, not just
medicine,” says Danylkiw. “Innovation
overall is positive especially coming from a
community hospital like St. Joe’s, it’s unbelievable. I can’t say enough about all of the
H
doctors, nurses and staff there.” ■
Michelle Tadique is a
communications associate at St.
Joseph’s Health Centre Toronto.

.YV\W)LULÄ[Z
for part-time and casual
hospital employees
and all hospital retirees

New program helps to
reduce readmission rates
By Akilah Dressekie
new program implemented at
Rouge Valley Health System
(RVHS) is helping to reduce
readmission rates for patients
once they are discharged. Studies have
shown that inadequate discharge support
contributes to a longer hospital stay, higher
risk of negative health outcomes, and readmissions. The Care After The Care in
Hospital – or CATCH – program hopes to
fix that.
“CATCH focuses on fully understanding and addressing patient needs upon
discharge to more adequately respond to
the challenge of readmissions rates,” says
Amber Curry, manager of the ambulatory
care unit, and pre-op clinic, Rouge Valley
Ajax & Pickering (RVAP), and fracture
clinic, RVHS.
The CATCH program was implemented
in November at both Rouge Valley hospital campuses – Rouge Valley Centenary
(RVC) and RVAP. It works to improve
patient flow by using physicians, nurses
and rehabilitation therapists, who work
together to help reduce the patient’s
chances of being readmitted for the same
medical issue. Their goal is to, ultimately,
help the patient return home sooner, and
to remain within the community. Patients
are referred to CATCH when they are discharged from hospital.

A

“CATCH helps our patients to better
manage their own conditions at home,
and to be aware of the supports available
to them right here in the community,” explains Aaisha Savvas, manager, complex
continuing care, RVC, and outpatient rehab services, RVHS. “We’re empowering
our patients by giving them the tools they
need to self-manage their conditions, helping to reduce readmissions.”

Studies have shown that
inadequate discharge
support contributes to
a longer hospital stay,
higher risk of negative
health outcomes, and
readmissions.
Interdisciplinary approach
One important element of the program
is the interdisciplinary approach between
the physician, nurse and physiotherapist in
helping to provide the patient with a better ability to manage their condition from
in the community. “The physician, nurse
and the therapist play a very important
and complementary role in ensuring the

patient’s needs get addressed in a more holistic way,” explains Curry.
Physician participation ensures that
there is appropriate medical follow-up
once the patient is discharged. A general
internist, based in the hospital’s general
internal medicine clinic, can address any
medication concerns or additional testing
needs, if required.
Both the nurse and physiotherapist play
a role in helping to educate the patient
about their condition, so that they will be
able to effectively self-manage in the community.
The nurse will assess the patient for different risk factors, including falls, medication, cognition, nutrition and even incontinence. With each of these risk factors,
the nurse can develop interventions for
individual patient needs. By helping to educate the patient on factors such as proper
diet and medication administration, they
can teach the patient how these factors
can improve their ability to self-manage
their condition.
By assessing the patient, the physiotherapist can prescribe an individualized reconditioning program. They can also help
to educate the patient on preventing falls
and deconditioning, and how to maintain
good physical activity in the community.
“After being assessed by the physiothera-

NATIONAL
NURSING WEEK
9th Annual Supplement
The May 2014 issue of Hospital News will be celebrating National
Nursing Week in Canada (May 12th – 18th) with a special pull-out feature
showcasing our “Nursing Heroes” contest winners as well as highlighting
outstanding leadership and stories from the nursing frontlines!

ADVERTISERS: Don’t miss this opportunity to
celebrate and acknowledge the outstanding
contributions of our hard working nurses with
your own THANK YOU ad!

Occupational Therapy/Physiotherapy
Assistant Carol Hylton-Ehlers gives
physiotherapy to a patient. Rouge Valley's
new CATCH program will target specific
patients once they are discharged,
providing improved support, and helping
to prevent future readmissions.
pist, patients are assisted to achieve their
physical and functional goals by a therapy
assistant in an individualized, small group
format,” says Curry.
The physiotherapist sees patients biweekly and can later assess if more therapy
is required, or if they can be referred to less
intensive community programs, such as exercise classes.
“We’re beginning to see improvements in the outcomes of our patients in
the CATCH program,” explains Savvas.
“Patients are able to return to the community in a much better condition, and with
H
improved function.” ■
Akilah Dressekie is a Senior
Communications Specialist at
Rouge Valley Health System.

know exactly the moment
that I decided to become a
music therapist. That moment
was at a hospital, where I was

the patient.
I was diagnosed with Type 1 diabetes
when I was 26 years old. At the time I was
working as a musician and freelance writer.
After experiencing many weeks of debilitating fatigue, dizziness, and weight loss,
I had visited my family doctor. A quick
blood test revealed that I had dangerously
high blood sugar, and needed to get to an
ER at once. It was there that I learned that
I had Type 1, and would be on insulin shots
for the rest of my life.
Being diagnosed with a life-changing
illness can trigger a host of overwhelming emotions. For me, numbness was the
strongest thing I felt. Lying in a hospital
bed for two days, hooked up to machines
and getting shots every hour, I tried to absorb information about my new disease,
and what my life would look like from now
on. There was no ER social worker that
came to visit, no clear moment where any
health care provider asked me how I was
doing with my diagnosis.
It was that first night in the hospital
where something dramatically changed for
me. I had just been woken up for my hourly
blood-draw, and couldn’t fall back asleep.

The person next to me was experiencing
some sort of pain crisis, and the ER was
generally a busy, noisy place to have a good
night’s sleep. Out of habit (being a lifelong
musician and singer), I began humming a
song under my breath, “Basement Apartment” by Sarah Harmer.

music can transform
patients’ experience
of their pain, provide
comfort, create
relationships, and even
soften the whole
hospital environment
Suddenly, I felt the tide of tears build up
inside of me. My whole body, it seemed,
was finally experiencing emotion. It was
as if the deeper breathing and bodily vibrations of just this simple humming was
enough to release all the fear, sadness,
grief, and shock of my new diagnosis. Singing, even so softly and for just a moment,
made me feel human again.
It was too much. I knew instantly that
I had to stop singing. The depth of emotion I was accessing was too big for this ER.
If I opened that floodgate of feeling, there
would be no one there to help me through

it. And I could not go through this swampland of feelings alone.
That’s when something crystalized for
me: this hospital needs more music therapists, I thought to myself with clarity uncommon for 2am. It needs more music
therapists so that people can safely fall
apart when they need to.
Several years later, I now have a master’s in music therapy, and a growing clinical practice in inpatient and outpatient
oncology. As the new music therapist at
Grand River Regional Cancer Centre in
Kitchener, I am a daily witness to how
music can transform patients’ experience
of their pain, provide comfort, create relationships, ease family dynamics, and even
soften the whole hospital environment for
patients and staff alike. Be it offering a patient a chance to express themselves on an
instrument, facilitating a drum circle with
a family around a patient’s bed, helping a
patient write a song to their loved ones,
or just quietly singing at a patient’s bedside, music never seems to fail at making
an impact.
One of the mandates of McGill University’s Programs on Whole Person Care is
to “create a space where healing may occur,” regardless of whether changing disease outcomes is possible. Music creates
this kind of healing space, and it is often

the smallest music that makes the biggest
impact. It took only a few notes of a Sarah
Harmer song, hummed under my breath in
an ER, to unleash the flood of emotion the
night of my diagnosis. On the inpatient oncology unit, working with some of the hospital’s sickest patients, often it is just quiet,
barely-audible singing or humming by the
patient’s side that can create the strongest
connection. While around them machines
beep, equipment clatters and nurses rush
in and out attending to endless interventions, just breathing and humming with a
patient can provide a simple thread of connection, focus, and beauty.
It is a privilege to be part of a multidisciplinary team committed to supporting the
whole patient through their cancer journey, and to be using music to help meet
this goal. My diagnosis story reminds me
of how easy it is to lose one’s identity in a
hospital bed, and the importance of music in delivering person-centred care. It
reminds me of what a powerful gift music
can be in the most vulnerable moments
H
of our lives. ■
Sarah Pearson MMT, is the Program
Development Coordinator of the Room
217 Foundation, a registered charity
dedicated to caring for the whole
person with music. www.room217.ca

NOMINATE A NURSING HERO!
Hospital News’ 9th Annual Nursing Hero Awards
COMMITMENT DEDICATION COMPASSION LEADERSHIP
Look around you. Have you been inspired, encouraged or empowered by an employee or
a colleague? Have you or your loved one been touched by the care and compassion of an
outstanding nurse? Do you know a nurse who has gone above and beyond the call of duty?
Now is your chance to acknowledge and recognize the nursing heroes in your facility or
community.

nual
9th AnSING
UR

N

HWEARRO
DS!
A

Hospital News will once again salute nursing heroes through our annual National Nursing
Week (May 12th to 18th) contest. We hope you will share your stories with us so that we can
highlight the exceptional work that our nurses are doing and how they touch our lives.
Nominations can be submitted by patients or patients’ family members, colleagues or
managers. Please submit by April 15th and make sure that your entry contains the following
information:
Full name of the nurse
Facility where he/she worked at the time
Your contact information
Your nursing hero story
Along with having their story published, the winner will also take home:
1ST PRIZE:
$1,000 Cash Prize

Mindfulness:
The quiet revolution at
Hamilton Health Sciences
By: Calyn Pettit
here is a quiet revolution going
on at Hamilton Health Sciences. The weapon of choice?
Stopping and breathing.
Health care workers are extraordinary–
they embrace those who suffer, while the
rest of our culture denies the reality of illness
and death. However, extending mind, body
and spirit everyday to support patients and
families in heart wrenching situations, and
working to improve care in a complex and
chaotic system, takes its toll. Studies confirm
that many helping professionals experience
high levels of compassion fatigue. Compassion fatigue refers to the profound emotional
and physical exhaustion that occurs over the
course of a career when workers are not adequately refueled or recharged to meet the
needs of their roles, colleagues and patients.
Over the past three years, Hamilton
Health Sciences has partnered with the
McMaster University Program for Faculty
Development (PFD) to offer staff, physicians, students and faculty access to courses
designed to alleviate compassion fatigue and
promote the resilience of people who work
in healthcare. Since its inception in 2011,
over 200 staff and physicians at HHS have
participated in the “Discovering Resilience”
program.

T

HOSPITAL NEWS MARCH 2014

“The first step to alleviating compassion fatigue is awareness of one’s physical
and mental state. Awareness is cultivated
through mindfulness, which means bringing one’s full attention to the present moment, in a non-judgemental way,” says Dr.
Andrea Frolic, director of the office of clinical & organizational ethics at HHS. “It
sounds simple, but our energies are pulled
in so many directions, it is often hard to
focus on the here and now. Mindfulness
requires practice, and these courses are designed to support frontline care providers
and leaders at HHS to develop a repertoire
of practices to reduce stress and enhance
resilience.”
Through funds provided through HHS’
new strategic plan, one goal of which is to
“Be the organization of choice for talented
people”, various mindfulness courses are
offered at significantly discounted rates
to HHS staff and physicians. One such
course, Mindfulness Based Stress Reduction (MBSR), provides an in-depth introduction to mindfulness practices and how
they can be applied in the clinical setting.
In addition, staff and physicians are welcome to attend free weekly drop-in, 30
minute sessions called “Mindfulness for
Lunch” offered across HHS’ hospital sites.

Andrea Frolic, director of the office of clinical & organizational ethics at Hamilton
Health Sciences, leads a group of staff members through a lunchtime mindfulness
meditation session at HHS’ St. Peter’s Hospital site.
“MBSR is an evidence-based therapeutic protocol that has been demonstrated
to enhance mental health and well-being,
and relieve many physical conditions,
such as chronic pain,” says Dr. Frolic. “It
teaches participants a range of practices, such as breathing meditation, gentle
stretching and mindful listening, designed
to enhance one’s connection to self and
others. Past participants report significant
benefits, including better sleep, less anxiety, greater enjoyment of work and improved relationships. These practices are
simple, anyone can learn them, but they
are truly revolutionary in turning the tide
from burn-out to resilience.”
Bonnie Buchko, a physiotherapist on
the clinical neurosciences unit at Hamil-

ton General Hospital has completed the
MBSR program and says it covered many
concepts that have supported her day-today work.
“Even when there isn’t time for a formal break, being mindful allows me to
take a break from the sometimes chaotic ward by stopping my mind, even for
half a minute,” says Bonnie. “This helps
me recharge and be able to enter my
next patient encounter with greater focus and presence. I’m more able to give
my patients the opportunity to express
what is important to them and what will
H
help them.” ■
Calyn Pettit is a public relations
specialist at Hamilton Health Sciences.

www.hospitalnews.com

PAIN CONTROL/COMPLEMENTARY HEALTH/HEALTH PROMOTION

Focus 11

A new dimension in cancer hope
By Margaret Valois
othing can ever prepare one for
a diagnosis of cancer. The emotional, psychological and physical impact is often overwhelming. Not only are the effects of treatment
punishing on the body, but the toll from
the shock followed by uncontrollable fear
often leaves patients reeling. Some say their
world stops. They feel isolated from what
is normal, cut off from their lives and very
much alone.

N

approximately 85 per cent
of patients are affected by
the often devastating nonmedical consequences of
cancer
As many as 40 per cent of Canadians will
be diagnosed with cancer and embark on
similar journeys at some point in their lives.
While they are fortunate to have access to
medical care that rivals any in the world,
the medical intervention they receive is
only one part of the healing process. Research shows that approximately 85 per
cent of patients are affected by the often
devastating non-medical consequences of
cancer â&#x20AC;&#x201C; the anxiety, depression, confusion,
fatigue, nausea and pain. But, when medical care is complemented with emotional,
rehabilitative and practical support, cancer
patients not only improve their quality of
life but have been proven to experience
an increase in longevity. It is in this area

of psychosocial healthcare that Wellspring
Cancer Support Network excels, and plays
a unique and crucial role in Canada.

a Money Matters case manager who will
assess their personal circumstances, provide options to help make the most of
available resources, and will identify
any government programs for which the
patient might be eligible.

A wealth of
innovative programs
Wellspring is a warm and welcoming
network of community-based centres in
Southern Ontario and Calgary, providing
a comprehensive range of supportive care
programs and services for anyone living
with any type of cancer, at any stage.
Led by qualified and experienced professionals including psychotherapists, physiotherapists, art therapists, dietitians and
more, Wellspringâ&#x20AC;&#x2122;s 40 programs span a wide
range of categories, from individual and
group support to rehabilitation services, to
practical guidance in areas such as nutrition, finance management and workplace
issues. The entire continuum of programming opportunities offered at Wellspring is
evidence-based, professionally evaluated
and developed and piloted through the
Wellspring Centre of Innovation.
Some of the innovative offerings at Wellspring include the Nourish series of twelve
nutritional education and demonstration
programs for people with site-specific cancers; for individuals in the treatment phase
of their illness who are challenged by palate
changes, medical interactions and loss of
appetite; or for those who have completed
treatment looking to ensure ongoing wellness and recurrence prevention.
Exercise is another critical tool in the
healing process with evidence showing that
benefits are gained when exercise is incorporated into treatment plans right from the

Beyond the door:
telling oneâ&#x20AC;&#x2122;s story

The personalized Cancer Exercise
program at Wellspring improves physical
functioning, fatigue management and
overall quality of life for people living with
cancer.
point of diagnosis. Exercise helps improve
physical functioning, fatigue management
and overall quality of life; it reduces pain,
the side-effects of treatment, improves
self-esteem, aids in better treatment compliance and even secondary prevention for
some types of cancer.
The award-winning Money Matters program helps patients work through the financial consequences of cancer, which for
many can be equally as harrowing as the
diagnosis. By curtailing the ability to work,
coupled with the host of unplanned expenses, cancer drastically affects a patientâ&#x20AC;&#x2122;s
livelihood. Patients concerned about their
finances are able to meet privately with

Every person who visits a Wellspring centre has a unique set of needs. While some
seek out single items of support, others immerse themselves in an array of programs
and activities. Those who find it difficult to
acknowledge that they need help find that
being surrounded by a community of peers,
who are survivors, is a very powerful first
step on the road toward healing.
Wellspring has helped tens of thousands
of men, women and children who have
been touched by cancer, as well as their
caregivers and loved ones. Beyond the benefits that they offer in the moment, Wellspringâ&#x20AC;&#x2122;s programs have the ultimate objective of building, in an unrushed manner, a
patientâ&#x20AC;&#x2122;s capacity to manage their own care.
Wellspring Centres are places of safety,
comfort, ease and confidentiality. Wellspring
charges no fees, and requires no medical
referral. For more information about a Wellspring centre near you, visit wellspring.ca or
call 416-921-1928. Wellspring receives no
government or other core funding, and is
funded exclusively by independent donors
H
and corporate partners. â&#x2013;
Margaret Valois is Director of
Communications, Wellspring
Cancer Support Network.

Spine stimulation tingles the pain away
By Alexa Giorgi
n 2011, Deborah Finbow’s
hand was bitten by an agitated
dog. The wound was treated
by her local emergency department, and she was sent home with antibiotics to prevent infection. However, after
the wound had healed, Finbow began to
experience very painful inflammation not
in her hand, but in her left foot. Her foot
would periodically swell, become discoloured, and burn and tingle with incessant
pain. The symptoms worsened with each
bout of inflammation. She was diagnosed
with osteomyelitis, a bone infection.
Despite a surgical intervention in March
2012 to relieve the now severe inflammation, the pain would not diminish. It was
determined that the infection had also
damaged the nerve in her foot which was
now causing the unbearable pain. This
time, she was diagnosed with Complex Regional Pain Syndrome (CRPS).
A married mother of four from Collingwood, Ont., Finbow could no longer put
any pressure on her foot and relied on a
walker and a cane to stand and get around
– if she could find the motivation to get
out and do anything. She couldn’t stay
warm, even in summer, because her body
assumed the same temperature as her foot
and leg: ice cold.
“Chronic pain takes everything out of
you,” she says. “The pain and discomfort
was so intense that I just wanted to stay
home in bed and sleep.”
Doctors didn’t think there was anything
they could do for her. She was told to get a
wheelchair and do her best to manage the
pain. But one physician thought it might
be worthwhile to see if any of the specialists at Toronto Western Hospital’s Krembil
Neuroscience Centre could help.
Finbow was first referred to Dr. Anuj
Bhatia, an anesthesiologist and pain specialist to determine whether other pain
medications might alleviate her CRPS. It
was the first time in a year that Finbow felt

I

Dr. Mohammed Shamji demonstrates how a spinal cord stimulator alleviates pain. Implanted wires deliver a controlled electrical
signal to the spinal cord, sending a tingling sensation to the brain while also blocking pain signals that the patient experiences
any hope her condition might improve.
Unfortunately the medication wasn’t effective, leaving Finbow sluggish, groggy, and
unable to participate in family life.
It was time to consider a final alternative: surgery. Finbow was referred to Dr.
Mohammed F. Shamji, a neurosurgeon
who specializes in minimally-invasive and
complex spine surgery as well as neuromodulation for neuropathic pain in hands
and feet. Conditions caused by neuropathic pain – damage to a complex sensory system responsible for how we perceive things
like touch and temperature – often have

symptoms of amplifying normal sensations
to the point of unrelenting discomfort. Patients can feel very hot or very cold, “pins
and needles” sensations, numbness, and
itching; much like what Finbow was experiencing.
Shamji is trying to organize a program
at Toronto Western Hospital especially for
treating patients with neurostimulation, a
surgically implanted device about the size
of a stopwatch in the epidural space around
the spine that delivers a controlled electrical signal to the spinal cord. The electrical impulses deliver a tingling sensation to

Questions for Nurses
Does your employer’s insurance provide you professional liability protection
for incidents which occur…
•
•
•
•

outside of the workplace?
when you help a neighbour or a stranger on the street?
when you volunteer?
when you do contract work?

The answer: Not

likely.

The professional liability protection (PLP) available to RNAO members is affordable,
portable and is completely independent of your employer.
PLP is now a requirement for nurses. Membership in RNAO satisﬁes the PLP requirement.
Not an RNAO member? Sign up now to ensure you comply with the PLP requirement.
RNAO fees may be deductible in taxation year 2014.

To sign up online:
www.RNAO.ca/join
or call Toll-free: 1-800-268-7199
HOSPITAL NEWS MARCH 2014

the brain while also blocking pain signals
that the patient experiences, essentially
overriding the pain sensation. The patient
is taught how to operate a remote control
that can change the intensity and patterns
of stimulation at any time, adjusting them
for different activities such as sleeping or
walking.
Although the technology has existed for
a few decades, it is not as well-known as a
treatment option for patients with severe,
chronic pain.
“Neuorstimulation is not for everyone.
Some patients don’t receive any benefit
from the device and others aren’t comfortable with the tingling sensation it generates,” explains Shamji. “However, we
are working on a system to get the right
patients to our program so they can be
evaluated and treated quickly since this
technology is underutilized, but can be extremely efficient in enhancing the quality
of life for these patients.”
Finbow was assessed as a candidate for
such a procedure, in her case called a spinal cord stimulator, but she was advised
that it might only lessen her pain by 50
per cent. She decided to go ahead with the
surgery.
The procedure more than exceeded Finbow’s expectations. Just two weeks after
the surgery, with her stimulator properly
programmed, Finbow no longer felt any
pain and could not only put weight on her
foot, but also walk around unassisted. She
is now getting back to the activities she
thought were lost to her forever such as
travelling and riding a bike.
“This whole ordeal started the year I
turned 50,” she says. “Thanks to Dr. Shamji, Dr. Bhatia and their whole team, I feel
like I’m restarting my 50s and resuming the
H
life I had.” ■
Alexa Giorgi is a Senior Public Affairs
Advisor, University Health Network.
www.hospitalnews.com

Ethics 13

The ethics of discharging

patients with vaccine
hesitant parents
By Jonathan Breslin, PhD
s an ethicist I try to always be
as balanced as possible when
I write columns like this one.
This is not because I donâ&#x20AC;&#x2122;t have
opinions or Iâ&#x20AC;&#x2122;m afraid to express them. Itâ&#x20AC;&#x2122;s
because an important part being an ethicist is to facilitate good decision making by
highlighting all the ethical considerations
with respect to the relevant issue. I also
tend to avoid statements like, â&#x20AC;&#x153;x is the
right thing to do,â&#x20AC;? or â&#x20AC;&#x153;y is morally wrong,â&#x20AC;?
largely because ethical issues tend to be
more complex than they appear on the surface, and there can often be more than one
reasonable response to an issue. But when
it comes to parents who refuse to vaccinate
their children, I have a hard time being balanced. I do believe that vaccinating oneâ&#x20AC;&#x2122;s
children is clearly the morally right thing
to do.

A

A paediatrician by the
name of Russel Saunders
recently wrote a column
that circulated through
social media entitled,
â&#x20AC;&#x153;Vaccinate your kids â&#x20AC;&#x201C;
or get out of my office.â&#x20AC;?
There are two reasons I believe this. One
is that vaccinations are a very low risk way
to prevent oneâ&#x20AC;&#x2122;s children from being infected with a debilitating or fatal illness. There
are literally dozens of studies published in a
wide range of academic journals that have
debunked all of the misconceptions related
to vaccine risk, including the proposed link
between vaccines and autism.
But donâ&#x20AC;&#x2122;t take my word for it â&#x20AC;&#x201C; download the American Academy of Pediatrics
document, â&#x20AC;&#x153;Vaccine Safety: Examine the
Evidence,â&#x20AC;? a 21-page summary of all the
published evidence related to vaccine
safety (recently updated in April 2013).
Some people even question the benefit of
vaccines, despite the fact that the introduction of vaccines virtually eradicated
diseases like polio from the human race.
And now, unfortunately, weâ&#x20AC;&#x2122;re seeing a resurgence of many of these illnesses around
the world, coinciding with dropping vaccination rates.
The second reason I believe that vaccinating oneâ&#x20AC;&#x2122;s children is the right thing
to do is because it helps to prevent harm
to others from contracting debilitating or
fatal illnesses. As the Canadian Paediatric
Society points out, a healthy unvaccinated
child can spread a vaccine-preventable
disease to more vulnerable individuals,
such as infecting an infant sibling with pertussis or a pregnant woman with rubella.
Not only that, but many of the infections
can only remain controlled if a critical
www.hospitalnews.com

mass of the population is vaccinated (herd
immunity). If too many parents refrain
from vaccinating their children, illnesses
like measles can make a resurgence and
spread around the world.
With that said, I want to shift to another aspect of the issue: the ethical responsibilities of paediatricians towards parents
who refuse to vaccinate their children. A
paediatrician by the name of Russel Saunders recently wrote a column that circulated through social media entitled, â&#x20AC;&#x153;Vaccinate your kids â&#x20AC;&#x201C; or get out of my office.â&#x20AC;?
He asks new parents in his practice if their
children are vaccinated, or if they plan to
vaccinate, as part of his intake process. If
they say no, he tells them to find another
paediatrician. His rationale for doing so
is that the physician-patient (parent) relationship is founded upon trust, which
means the parents of his patients must be
able to trust his judgment and expertise. If
they canâ&#x20AC;&#x2122;t trust his judgment recommending vaccines, something that he believes
is so clearly the unambiguous standard of
care, how will they trust his judgment if
the medical issues become more complicated? While he raises some valid points,
the question is whether discharging such
parents from his practice is an ethically appropriate response.
Both the American Academy of Pediatrics and the Canadian Paediatric Society
recommend against discharging vaccinerefusing parents from practice, for several
reasons. First, evidence shows that counseling does change the minds of many
parents who initially refuse vaccines (or
are at least reluctant to consent to vaccines). Scott Halperin categorizes vaccinerefusing parents into five groups, most of
which can be counseled or reasoned with
(though it can take time). Only a very
small percentage of parents are so committed to the anti-vaccine position that they
canâ&#x20AC;&#x2122;t be convinced otherwise. Thus, it is
important for paediatricians to understand
which group the parents belong to. (The
Canadian Paediatric society refers to these
parents as â&#x20AC;&#x153;vaccine-hesitantâ&#x20AC;? to reflect
the fact that not all of them are adamant
about refusing vaccines).
Second, discharging vaccine-hesitant
parents certainly does not further the
paediatricianâ&#x20AC;&#x2122;s goal of promoting child
health. Discharge risks further alienating
such parents and may fuel their distrust
in the health care system, which can end
up having detrimental effects on their
children. Discharge from practice cuts off
all lines of communication and eliminates
any chance for the paediatrician to build a
trusting therapeutic alliance for the good
of the child(ren). Additionally, if there are
too many paediatricians who refuse to accept vaccine-hesitant parents into their
practice, these parents may have difficulty
finding primary health care for their chil-

dren. Not only does this increase the risk of
potential harm to the children, but it also
denies these parents equitable access to
healthcare (especially in smaller communities with few paediatricians available).
In some extreme cases, if all efforts to
work with the parents have failed, paediatricians may be justified in discharging such
parents from their practice. The College of
Physicians and Surgeons of Ontario policy
states that physicians are not justified in
ending a therapeutic relationship merely
because the physician disagrees with the
patient or because the patient refuses to
follow the physicianâ&#x20AC;&#x2122;s advice. There must
be a â&#x20AC;&#x153;breakdown of trust and respectâ&#x20AC;? in
the relationship for discharge to be justified, and even then the physician is obligated to ensure that the patient has arranged (or has been given reasonable time
to arrange) alternative services. Simply discharging them and sending them on their
way is not an ethically appropriate way to
H
respond to vaccine-hesitant parents. â&#x2013;

Jonathan Breslin, PhD is Assistant
Professor, Institute of Health Policy,
Management and Evaluation, University
of Toronto Ethicist Member, University
of Toronto Joint Centre for Bioethics.

“I feel this is a looming public health
crisis,” explains Dr. Jane Finlay, a Vancouver-based practitioner who counsels
vaccine-hesitant parents. Dr. Finlay is
also a member of the Canadian Paediatric
Society’s (CPS) Infectious Diseases and
Immunization Committee. “I often hear
concerns about formaldehyde in vaccines
– but there is more in a peach than any
of the vaccines,” explains Dr. Finlay, who
tries to get parents to understand the serious risks associated with refusing vaccination. “When you are crossing the street are
you looking up at the sky for an airplane
to fall on you or are you going to watch
for traffic?”
In July 2013, the Public Health Agency
of Canada identified 30 cases of measles
in six different provinces – five times the
number of cases confirmed by the same
point in 2012. By the fall, Alberta confirmed 42 cases of measles. The province
declared the outbreak over this past January – only to reissue a warning a few weeks
later when new cases resurfaced. Measles
is the leading cause of death in children
worldwide and can cause pneumonia,
deafness and brain damage. The vaccine
has been available in Canada since 1963.
At least 13 children have died from
pertussis in the past 10 years. The majority of deaths occurred in infants less than
two months – they were too young to be
vaccinated – highlighting society’s role in
vaccinating to protect others. From October 2011 to April 2013, Ontario experienced a large outbreak with 441 cases. As
Hospital News went to press, at least six
people in Prince Edward Island had pertussis in 2014. That number seems certain
to rise across the country.

The anti-vaccine
movement is small, but
has a very large voice
How vaccines work
Vaccines expose the patient to a very
small, safe amount of viruses or bacteria.
The patient’s immune system learns to
recognize and attack the infection in case
of future exposure. As a result, the patient
will not become ill or will suffer only a
milder infection.
More importantly, vaccines protect
society’s most vulnerable like newborns,
the elderly, the immunocompromised,

the pregnant or those who cannot be vaccinated because of medical reasons. By
preventing contagion, vaccines shield the
entire community. It’s harder to catch an
illness, if those around you have already
fought it off. This is also known as herd
immunity. Collective resistance fluctuates
by disease, but usually falls between 85
and 95 per cent. That’s why Canada’s falling child vaccination rate is so alarming.
A UNICEF study published last year
found that only 84 per cent of Canadian
children were immunized for measles, polio and DPT3, placing Canada in secondlast place out of 29 of the world’s richest
countries. (In contrast, Greece topped the
list with a 99 per cent immunization rate
–in spite of its instability and economic
crisis.) Canada’s low childhood immunization rate makes it easier for these highly
contagious diseases to find holes in our
collective barrier.
The Public Health Agency of Canada
(PHAC) contests the UNICEF study and
says that the current vaccine coverage estimate for DTP, measles and polio, is over
95 per cent coverage. Even still, experts in
the field say Canada could be doing a lot
better.
“I am deeply embarrassed when I go
outside of Canada to immunization meetings to come from an OECD country with
such a poor immunization uptake rate,”
says Dr. Noni MacDonald, professor of
paediatrics at Dalhousie University, IWK
Health Centre and Canadian Centre for
Vaccinology.

Complacency and
ambivalence fuel
vaccine hesitancy
One reason Canadians are hesitant to
vaccinate is the absence of imminently
threatening disease. Without a visible
present danger it’s easy for parents to grow
complacent.
“Canadians are privileged to live at a
time when people no longer remember the
severity and how common these illnesses
were. Eighty years ago, it was common for
children to pre-decease parents in their
first five years,” explains Dr. James Talbot,
Alberta’s chief medical officer.
It’s because of the generations before
us, he says, that we live in a time when infant mortality is considered a tragedy, and
not a common occurrence.
“A slide show of the average pediatric
ward from the 1950's and 1960's would illustrate what catastrophes await,” warns
Dr. Hirotaka Yamashiro, chair of the pediatrics section of the Ontario Medical
Association and president of the Pediatricians Alliance of Ontario. “There is no
doubt that the easy access to information,
good and bad, has accelerated this process
with misinformed or maliciously-inclined
individuals given the same credibility as
those who have expertise.”
This leaves the need to stress vigilance
on the shoulders of practitioners – many
who are struggling to have quality time
with each patient. “The fee schedule
encourages a higher volume practice so
many can’t spend a half hour discussing
vaccination,” says Dr. Finlay.

Physicians urged
to be patient, persistent
“There are few downright refusers for all
vaccines, but there are many who are hesi-

On weighing the risks of
vaccination one expert
says: “When you are
crossing the street are
you looking up at the sky
for an airplane to fall on
you (risks of vaccines) or
are you going to watch
for traffic?”

tant,” says MacDonald. Finlay and MacDonald encourage health care workers to
be patient with parents. They urge doctors
to find out what’s behind the parent’s ambivalence. And while many doctors are
tempted to dismiss the patient from their
practice, Finlay and MacDonald argue it’s
in the child’s best interest to be respectfully persistent with the parents – even if it
takes multiple visits.
“One of the most effective interventions with parents is to be a good listener.
It is important to engage parents in a proactive, honest discussion, rather than lecturing. We also must address unfounded
allegations about vaccines, refute misinformation and provide credible sites and
resources,” says Shelly Landsburg, director
of the communicable disease control with
the office of chief medical officer of health
in New Brunswick.
Alberta’s Chief Medical Officer of
Health says every health encounter – even
in social settings – is a valuable opportunity to improve outcomes. “The decision
to get immunized is heavily influenced by
health care professionals in personal and
professional relationships. Never underestimate how you will affect a parent’s decision,” says Dr. Talbot.
The side effects of vaccines are minor
when compared to the possible effects
of not vaccinating: death, brain damage
or permanent disability. The benefits,
however, are overwhelming: less antibiotic use; fewer hospitalizations and invasive treatments and tests; fewer longterm disabilities and diminished risk of
childhood strokes.

Misinformation
messages online
Despite the overwhelming scientific
evidence in support of vaccine safety,
a quick Google search will reveal an active opposition. Purported ‘experts’ use
flawed logic and science to contribute to
parental confusion.
“Parents have access to a wealth of
information and many sources of misinformation, including television documentaries, magazines, and hundreds of antivaccine web site links,” says Landsburg.
“The difficulty for parents lies in trying to
figure out which information to believe.”
Those parents who don’t vaccinate their
children base their decisions on what they
believe is sound research. One mother told
Hospital News that she read an article on
the negative side effects, which confirmed
her intuition against vaccines. Another
parent said scientific articles defend his

choice not to vaccinate his 15-month-old
son, citing a recent study that found vaccinated baboons infected others with the
illness. The study justified his belief that
vaccines are dangerous; meanwhile, the
scientists who led the study believe their
results will help improve vaccines.
“We need to teach the difference between one anecdotal case and high-quality
scientific studies,” says Dr. Joan Robinson,
a Pediatric Infectious Diseases specialist
in Alberta.
“Vaccines are still the most cost effective way to ensure that you see your child
graduate from high school or attend their
wedding,” says Dr. Talbot.
Admittedly vaccines are not 100 per
cent effective all the time. Three Calgarians diagnosed with measles this year were
immunized for the illness. “We are still investigating those cases,” explains Dr. Talbot. “But even then, they were only mildly
affected by measles. Compare that to the
outbreak we had in south Alberta, where
the community was not immunized. The
spread was much faster.”
Still, Dr. Talbot’s assurances frequently
fall on deaf ears.
“The anti-vaccine movement is small,
but has a very large voice. Canadians are
not immune to their messaging,” says Dr.
Flanders, director of Kindercare Pediatrics
and staff physician at North York General
Hospital in Toronto.
Pediatricians and emergency room physicians confront the consequences of online misinformation every day. One emergency physician told Hospital News of an
intentionally unvaccinated toddler who
was admitted with fever and a sore neck.
The young child had to undergo blood
tests and a spinal tap to rule out meningitis. The doctor says the child’s suffering and expensive procedures were both
avoidable.
Unvaccinated adults are also at risk. “A
patient came into our emergency department with weakness and couldn't breathe
properly. This patient was diagnosed with
tetanus and almost died. Routine vaccinations and boosters could have easily prevented this,” says Dr. Glen Bandiera, chief
of emergency medicine at Toronto’s St.
Michael’s Hospital.
Many unvaccinated patients’ parents
base their decision-making on a movement which grew from an infamous, now
refuted, study published 16 years ago.

Debunking myths

In 1998, The Lancet published a study
claiming a link between autism and the
vaccines that prevent measles, mumps and
rubella (MMR). The study was quickly
called into question. The results could not
be replicated by other scientists and subsequent research cleared the MMR vaccine
of any connection to autism. The medical
journal retracted the study and the lead
researcher was stripped of his medical licence, and charged with acting “dishonestly and irresponsibly” in his research.
Other common concerns include that
vaccines overload the immune system,
and undermine the body’s natural ability
to protect. Babies are born with antibodies but they are temporary, and leave the
child vulnerable to deadly illnesses. There
is no evidence that vaccines overload or
overwhelm the system.
Continued on page 15
www.hospitalnews.com

PAIN CONTROL/COMPLEMENTARY HEALTH/HEALTH PROMOTION

Focus 15

Vaccine controversy
Continued from page 14

There’s also no scientific evidence that
vaccines or their ingredients, cause multiple sclerosis, brain damage, increase risk
of asthma, or SIDS. Patients are encouraged to sit with a trusted health care professional and address all their concerns.

Other obstacles
to vaccination
There are some parents, however, who
don’t even know which questions to ask.
Often these parents are new Canadians
or struggle to meet basic needs because
of low-income issues. “Our studies show
that new immigrants, for whom language
may be a bit of a barrier (…) they may
not know that these things are available
or that they are free,” explains Dr. Talbot.
Poverty is another factor according to
studies out of Manitoba and Ontario.
“A number of factors influence childhood immunization rates. The most important ones appear to be mother’s age
at child’s birth (>24 years old), higher
family income, continuity of care, primary
care physician, and having fewer than four
siblings,” says Dr. Alan Katz, professor of
Family Medicine and Community Health
Sciences at the University of Manitoba,
and associate director of the Manitoba
Centre for Health Policy.

Collective protection vs.
Individual choice
“Canadians respect the rights of individuals to make choices. In many countries childhood immunization is not a

www.hospitalnews.com

choice but is required by law. Others, like
Australia, provide financial incentives to
parents who have their children vaccinated,” says Katz.
While Canadian law protects the right
of the individual – ethically – vaccine advocates argue for the collective protection
over individual choice. “If we can’t overcome vaccine hesitancy with education
and supportive strategies, it may be time
to consider making vaccination mandatory for a child to be enrolled in activities
which bring them into contact with other
children,” suggests Dr. Finlay.
One medical ethicist agrees. “It is ethically irresponsible to refuse vaccinations
and put other children at risk,” says Maya
Goldenberg, associate professor at the
University of Guelph. “Your willfully unvaccinated child might spread the disease

A UNICEF study found
that only 84 per cent of
Canadian children were
immunized for measles,
polio and DPT3, placing
Canada in second-last
place out of 29 of the
world’s richest countries.

to a baby that hasn’t been vaccinated yet
(too young) or someone who is immunecompromised and therefore unable to be
vaccinated. Our public health system also
needs to pay for those intentionally unvaccinated children that become ill and
require care.”

Improving outcomes
Where Canada goes next in our efforts
to improve vaccination rates is contested.
Public health advocate and Globe and
Mail Columnist André Picard has some
suggestions.
“We need a single, coherent childhood
immunization schedule (not 13 different
ones in each province/territory); harmonized funding so the same essential vaccines are available to all Canadians; and
a national immunization registry to link
data across the country,” says Picard.
Alberta’s Dr. Talbot thinks a registry
will do little to increase rates, but agrees
that federal funding could help provincial
initiatives. Both men agree that public
health officials and health care providers
need to amp up public health education
and communicating vaccines’ benefits.
“Misinformation is widespread and
public health officials are passive and
timid,” says Picard. Picard also argues
that we need to move beyond our exclusive focus on childhood vaccination and
pay more attention to young adults. “The
outbreaks of measles are in college-age
kids who have no idea they’re not vaccinated; the mumps and pertussis out-

breaks are in young adults who require
boosters but we make no effort to reach
out to them. And then there are seniors
who could benefit from shingles vaccine,”
says Picard.
CPS co-authors MacDonald and Finlay would like to see a national committee to examine vaccine hesitancy and develop strategies. “We are already seeing
some provinces moving in this direction
but we need to learn from each other and
work together. Not fragment our talents
and resources,” says MacDonald.
“There are already so-called national
standards like NACI, but the problem is
implementation,” explains Dr. Yamashiro.
“The way federal funding of healthcare is
decentralized makes it harder to create
cohesiveness across the country. Unless
there is a universal will to implement any
such strategy, it would likely not be successful.”
All the health care advocates agree on
one aspect: public education. They urge
all health care workers to embrace the responsibility to debunk myths and be louder than the voices muddying the waters.
“I think the vast majority of parents want what is best for their children,” says Flanders. “Armed with the
right information, and protected from
false anti-vaccine propaganda, they will
inevitably make the right choices for
H
their children.” ■
Tania Haas is a freelance journalist.
www.taniahaas.com

MARCH 2014 HOSPITAL NEWS

PAIN CONTROL/COMPLEMENTARY HEALTH/HEALTH PROMOTION

16 Focus
A 1937 Iron Lung from the
Museum’s collection restored
at the Canadian Conservation
Institute in 2013, is a centrepiece of the exhibition.
This iron lung is one of 28
constructed at Toronto’s
Hospital for Sick Children
during the polio epidemic of
1937. So many cases were
admitted to hospital that an
‘emergency’ crew of engineers
and tradesmen ran an
assembly line in the basement
of the hospital to construct
the iron lungs. The iron lungs
were paid for by the Ontario
government and shipped to
parts of the province where
they were needed during the
epidemic. This one was used
in Kingston General Hospital
for several decades.

Vaccines & Immunization:
Epidemics, Prevention and Canadian Innovation
By Pamela Peacock
accines save lives. The history of disease, epidemics, and
public health clearly demonstrates this. And yet, there
has always been a very vocal opposition
to vaccines, an opposition that continues
to rage in very public forums. More public
education about the benefits and potential risks of vaccines – which are typically
quite minimal as vaccines are a highly
tested and regulated product – is needed
to enable people to make educated, con-

V

sidered choices about whether they vaccinate themselves and their children.
The exhibit, Vaccines & Immunization:
Epidemics, Prevention and Canadian Innovation, which opened at the Museum
of Health Care in November and will remain as a semi-permanent exhibit for the
next several years, attempts to do just this.
Developed with Guest Curator Dr.
Christopher Rutty, and funded in part
rt
by the Kingston and United Way Commmunity Fund, the Coalition of Canadian
n

Healthcare Museums and Archives,
and Sanofi Pasteur, the exhibit uses case
studies of diseases that saw significant
decreases in the twentieth century because of immunization – smallpox, diphtheria, polio, and whooping cough – to
identify the cost of epidemics to society
and explore the search for adequate treatment and preventative measures, such
as vaccines.
By discussing the impact of epidemics on individuals and society in the

short- and long-term, and showing how
drastically vaccines affected incidence
and mortality rates, the exhibit strives to
make people think not only of the risks
(perceived or real) of vaccines but also
why they were celebrated discoveries.
Let us look more closely at the case of
polio, which is a focal point of the exhibit.
Polio presents initially much like the flu.
Continued on page 17

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HOSPITAL NEWS MARCH 2014

Three members of a family brought to the hospital with the mother who
was suffering from small pox. The child in the center was unvaccinated.
The other two had been vaccinated the previous year because of school
vaccination requirements. These two children remained in the small pox
wards several weeks and did not contract small pox. Image courtesy of
Sanofi Pasteur Canada (Connaught Campus) Archives.
www.hospitalnews.com

Franklin Delano Roosevelt contracted polio in
1921 while vacationing in New Brunswick.
He later spearheaded the foundation of the
March of Dimes, which raised much needed
funds to support polio research.
Image courtesy of the March of Dimes.

Vaccines &
Immunization
Continued from page 16
Throughout much of history, most people were exposed to polio in their youth
creating adult immunity; however, by the
early twentieth century improvements in
hygiene meant that more and more adults
had never been exposed to polio and were
vulnerable to the disease. Many people
are able to fight off the disease with only
minor symptoms, but in others the viral
infection affects the nerves causing muscle weakness and paralysis. In the most
life-threatening cases, paralysis affects the
tongue, throat muscles and diaphragm,
leaving the patient at great risk of suffocation.
How was the disease treated in the
past? For some, paralysis was temporary
and with rehabilitation therapy full mobility could be restored. Others required
braces, canes, or wheelchairs for the rest
of their lives. Similarly, for those who suffered through bulbar polio – affecting the
respiratory system – the primary treatment
was an iron lung. Iron lungs use negative
pressure to inflate and deflate the lungs of
the patient inside, helping them to get oxygen. The patient’s body is placed inside
the iron lung while the head and neck protrude onto a canvas stretcher at one end.
When the motor is running, pressure will
alternatively build up inside the machine,
causing the lungs to become smaller, and
then decrease inside the machine, causing
the lungs to expand and fill with air.
Since cases of polio seemed to increase
in the warmer months, fear and anxiety
settled over many communities in the
summer and early fall. Parents would keep
their children close to home and forbid
activities, such as swimming in the local
pool, that were associated with contracting of polio.
The polio virus was first isolated in
1908, but the search for a polio vaccine
made great strides in the 1940s and 1950s
thanks to innovations by a number of rewww.hospitalnews.com

Dr. Jonas Salk discovered
the first polio vaccine in 1954.
Image originally published
in Health, April-May 1955.
searchers. Connaught Laboratories made
critical contributions when its scientists
discovered a synthetic medium in which
to grow the virus and a way to effectively
grow large amounts of virus by rocking the
cultures. This enabled enough vaccine to
be produced to conduct field trials of an
inactivated polio vaccine developed by Dr.
Jonas Salk in 1954. North America waited
on tenterhooks to hear the results, broadcasted on 12 April 1955. The vaccine was
successful at protecting against polio! It
should not be underestimated how excit-

ing this news was. From a peak rate of 60
cases per 100,000 in the early 1950s, incidence dropped to nearly zero by 1962.
With a vaccine for polio only discovered
in 1954, many Canadians can still recall
the fear of polio and remember friends and
family members who were stricken with
the disease; yet, younger generations have
little personal connection to the disease
and less understanding about what its consequences can be.
Without being educated about the dangers of polio – which is still endemic in

several countries – and other infectious
and contagious diseases it is possible that
the much publicized “risks” of vaccines
will have no counter-balance. It is important to provide balanced, well supported
evidence to people so that they can make
informed decisions. We hope that this exhibit will contribute to critical reflection
and much needed discussions around the
H
family dinner table. ■
Pamela Peacock is the former Curator,
Museum of Health Care in Kingston.

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MARCH 2014 HOSPITAL NEWS

18 Focus

PAIN CONTROL/COMPLEMENTARY HEALTH/HEALTH PROMOTION

Ontario Health Study gives everyday people a chance to

improve public health
By Hal Costie
early 225,000 Ontarians have
helped advance the public
health of future generations
right from their computers by
taking the Ontario Health Study’s (OHS)
online questionnaire. The OHS continues
to recruit participants to provide important
health data and samples. This information
will help researchers understand the risk
factors and causes of chronic diseases and
to develop new prevention strategies and
treatments.
Getting involved in the OHS is a simple,
straightforward process. Anyone who is 18
years of age or older and a resident of Ontario can take part in the Study. They just
need to go to www.ontariohealthstudy.ca,
register and then take the survey, which
takes about 45 minutes. The OHS follows
strict privacy practices that govern how
personal information is collected, who can
see it and how it can be used.
The OHS recently celebrated its third
anniversary, and is already one of the largest long-term health studies in Canada.
The OHS continues to enrol new volunteer participants to take the online questionnaire. Some participants have taken
their involvement further with 5,800 providing a sample through the Blood Collection Program and 3,600 have paid a visit to
the Toronto Assessment Centre to provide
other physical measures.
“Long-term health studies like the OHS
are essential to our understanding of chronic diseases,” says Dr. Vivek Goel, Principal
Investigator of the OHS and President and
CEO of Public Health Ontario. “With only
a small investment of your time you can
make a real and lasting difference in the
health of future generations. We appreciate the participation of so many Ontarians,

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A health study participant has blood drawn at the assessment centre.
and if you haven’t yet joined the study, I
encourage you to sign up today.”
The OHS is just one piece of an even
larger national effort called the Canadian
Partnership for Tomorrow Project (CPTP).
The CPTP consists of the OHS and four
other regional studies: The BC Generations Project, Alberta’s Tomorrow Project,
Quebec’s CARTaGENE and the Atlantic
PATH. Nationally, the CPTP has more
than 289,000 participants aged 35 to 69
and more than 100,000 have provided a
blood sample.

“By joining this landmark study, Canadians have contributed to the creation of
a rich national bank of health information
to help researchers answer fundamental
questions about the causes of cancer and
chronic disease for future generations.
This platform will be available for researchers beginning in 2015 and will serve as an
important resource for decades to come,"
says Dr. Heather Bryant, Vice President,
Cancer Control, Canadian Partnership
Against Cancer.
Those who want to contribute even
more to the Ontario Health Study can add
their name to a pool of participants who
are interested in providing a blood sample
or visiting the Toronto Assessment Centre.
The OHS Blood Collection Program is
run in partnership with LifeLabs, which
operates a number of Patient Service Centres located around the province. Those
invited to provide a blood sample simply
fill out a five-minute questionnaire online
and then take their requisition form to
the nearest LifeLabs Patient Service Centre. Not all those who express interest in
providing a blood sample or visiting the
Toronto Assessment Centre will be chosen
to participate.
“The information provided in the initial
online questionnaire provides us with an
overall snapshot of the health of Ontarians as well as their exposure to chronic
disease risk factors,” says Dr. Karen Menard, Chief Planning and Administrative
Officer of the OHS. “By providing a blood
sample or visiting the Toronto Assessment
Centre, participants allow us to get a more
detailed look at their health. We can then
compile this data to draw broader conclusions about the health of the overall population.”
Menard says that although the Study
has grown quickly over its first three years
it is important for Ontarians to keep participating. “In three years we have had

Photo JP Moczulski, CP Images.

How to get started:
• Visit www.ontariohealthstudy.ca to
register for the Study and complete
the online questionnaire. It only takes
about 45 minutes. You have six weeks
to complete the questionnaire from
the time you start it;
• After you have completed the
questionnaire you will be able to
volunteer to provide a blood sample
and/or visit the Toronto Assessment
Centre by clicking on the appropriate
“Express Your Interest” button. Not all
those who volunteer for this portion of
the Study will be selected;
• If you are selected for blood
collection or a visit to the Toronto
Assessment Centre you will receive an
email invitation;
• Once you receive this email, log into
your OHS account and click on the
orange “Next Step” button to proceed
with arranging your participation;
• If you have any questions you can
speak to an OHS staff member by
emailing info@ontariohealthstudy.ca
or calling 1-866-606-0686.
more than 200,000 people complete the
questionnaire and the Study has gained
the endorsement of Ontario’s universities,
research teaching hospitals and other relevant organizations,” she says. “But this is
just the beginning of a very long-term project. Now we are working on taking this
great opportunity to as many communities
as possible to keep this momentum going.”
The Study is currently focusing on faceto-face outreach with community groups
and hospitals. If you would like someone
from OHS to visit your organization to discuss the Study, contact Jocelyn Garrett at
H
Jocelyn.Garrett@ontariohealthstudy.ca. ■
Hal Costie is a Senior Communications
Officer at The Ontario Institute for
Cancer Research.
www.hospitalnews.com

Nursing Pulse 19

A story of
fire and ice
A group of northern nurses had to ‘hurry hard’’
e
to transform a curling rink into a health centre
following a devastating fire.
By Daniel Punch
large section of the Moosonee
Health Centre was smouldering. The charts of nearly 9,000
patients were covered in soot.
It was December 2012, and the Weeneebayko Area Health Authority (WAHA)
had no choice but to send out an alert that
read: “To all residents of Moosonee: Please
be advised that due to fire and smoke
damage…Moosonee Health Centre is
closed for all medical treatment effective
immediately.”
The small town near the southern tip of
James Bay, inaccessible by road, was without a health-care facility. The nearest hospital is a 10-minute helicopter flight away
on Moose Factory Island. No one was injured in the blaze, caused by an electrical
fire that ignited in a storage room, but 70
per cent of the centre’s supplies and equipment was lost.
The nurse-led Moosonee Health Centre employed 12 RNs and an NP working on rotation. They provided primary
care, emergency services and dispensed
medication, but were now without a roof
over their heads. “We’re thinking ‘what
happens next? What if we have an emergency, what are we going to do?’” says RN
Weena Saunders, director of patient care.
“We wanted to get (re)established quickly,
so people would feel safe and have a place
to go.”
Fire may have destroyed the centre, but
the solution would soon come on ice.
With the help of the close-knit
Moosonee community and Ontario’s
Emergency Medical Assistance Team
(EMAT), Saunders and her colleagues
now provide care in the unlikeliest of venues – the town’s curling rink.
Mike Merko and his eight-member
EMAT deployment team, specially trained
in disaster management for all kinds of
medical emergencies, put boots on the
ground in Moosonee roughly 24-hours
after the fire. They boarded a plane in
Toronto on a mild, late-autumn day, and
stepped off into a bone-chilling minus 32
degrees in Moosonee, proclaimed The
Gateway to the Arctic by its railway station
sign. “The cold was the first shock,” recalls Merko, EMAT incident commander.
He would soon discover that cold would
be a constant challenge throughout
this deployment.
The team found patients temporarily
diverted to the ORNGE helicopter hangar
10 minutes outside of town, where nurses
performed triage, and some patients were
airlifted to Moose Factory Island. Other local nurses had started the process of setting
up shop in Moosonee’s curling rink, part
of a larger facility which includes a skating rink and community hall. It was chosen because it already served as the town’s
emergency meeting point.
Though it hadn’t been used for years
and the ice was gone, the rink was designed for temperatures barely above the
www.hospitalnews.com

A

freezing mark. “Our biggest challenge
nge was
to take something that was designed
ed to be
cold and make it hot,” Merko says.. EMAT
is trained in everything from fighting
ing outbreaks to resuscitating critically injured
patients, but heating and cooling was outside of its expertise.
At first, they could only raise the temperature to 14 degrees despite an arsenal
of heaters. “You can’t expose and assess a
patient in that environment,” Merko says.
When the team realized the heat was rising to the top of the rink’s seven-metrehigh ceilings, they strategically placed
six rotating fans to push the warm air
down, and the temperature climbed to
24 degrees.
Merko says he admires the Moosonee
nurses for their tenacity despite many
constraints, including the town’s isolation. When the team needed an electrical
breaker, they couldn’t just pop in to the
local big-box hardware store. Everything
had to be sourced and brought in by air or
train. “They’re an amazing group of people,” he says. “We probably learned more
from them and how they deal with logistical issues.” The nurses, with help from
community members, wired the rink for
electricity, built accessibility ramps, and
addressed plumbing challenges.
The next major issues were infection control and privacy. EMAT came
equipped with seven large positive/negative pressure tents, capable of refreshing
a room’s air supply 15 times per minute.
The light, plastic tents can be set up in
less than 30 seconds, and served as the
centre’s makeshift ER and examination
rooms, providing much-needed visual
barriers.
“It was like rebuilding a clinic from
the ground up,” Saunders says. “You improvise and compromise; you try to make
things happen.”
More than a year after the fire, nurses
are still providing care in Moosonee’s old
curling rink. Work to rebuild the old location has stalled, and it won’t be ready for
months. Inside the arena, the huge blue
and white EMAT tents are still dwarfed
by the massive room. Medical supplies
and equipment line all four walls. A
makeshift staff lounge is cordoned off in a
corner with drapes held up by PVC pipes
and buckets. During the day, the crash of
hockey pucks and slash of skates can be
heard beyond one wall. Some evenings,
music blares in from community dances
held beyond another.
“You feel like you’re in a different
world,” Saunders says. “(But) it’s business
as usual.”
Saunders says nurses and patients
are getting used to their unusual surroundings. The number of patient visits,
which dipped following the fire, is back
to normal. The temporary centre is now
equipped for nearly every procedure available at the old centre. Nurses are forever

thankful for EMAT, who Saunders calls
their guardian angels.
“They were like our drill sergeants, but
in a good way,” Saunders says of EMAT.
“They pumped (us) up and gave (us)
something to look forward to.”
Sadly, the fire wasn’t the only tragedy to
strike Moosonee that year. The attention
of the country turned on the small town
after the May 31, 2012 ORNGE air ambulance crash that killed four people. The
helicopter took off from the Moosonee
airport carrying two pilots and two paramedics and went down just 850 metres
away.
“It really hit hard because we work
closely with the paramedics,” says Saunders. “But the community came together. We put an orange ribbon on the

door (of the health centre) so when everybody walks in the clinic, they think
about ORNGE.”
Through it all, the Moosonee Health
Centre hasn’t lost a single staff member.
In a region where the average turnover
rate is about a year, this is impressive. “It
shows the staff is dedicated to the patients
and the people of the region,” says Nicole
Blackman, an RN and director of professional practice for WAHA. “To not give
up and keep persevering and finding new
options and working well with the options
H
they were given, this staff is resilient.” ■
Daniel Punch is editorial assistant for
the Registered Nurses’ Association
of Ontario (RNAO), which represents
registered nurses wherever they
practise in Ontario.

MARCH 2014 HOSPITAL NEWS

PAIN CONTROL/COMPLEMENTARY HEALTH/HEALTH PROMOTION

20 Focus

Enforcement of Natural Health Products
By Deborah A. Campbell
lternative medicine and especially Natural Health Products
(NHPs) are growing in use, but
when people visit hospitals and
ask about such things, most health care
practitioners they encounter have little
knowledge in this area.
The NHP Products Regulations came
into effect in 2004 and define the category
as vitamins and minerals, herbal remedies,
homeopathic medicines, traditional medicines such as traditional Chinese medicines, as well as probiotics, and other products like amino acids and essential fatty
acids. Why is this important? According
to a 2010 Ipsos-Reid survey, 73 per cent
of Canadians regularly take vitamins and
minerals, herbal products, and homeopathic medicine.
The role of the NHP Directorate â&#x20AC;&#x201C; itâ&#x20AC;&#x2122;s
part of the Health Products and Food
Branch of Health Canada â&#x20AC;&#x201C; is to ensure
that we have ready access to NHPs that
are safe, effective and of high quality. But
NHPs are over-the-counter products and
donâ&#x20AC;&#x2122;t require prescriptions, and keeping
tabs on their sale and distribution isnâ&#x20AC;&#x2122;t easy.
Consider the retailer who faced repeated Health Canada recalls because of
selling products found to contain hidden
ingredients and unauthorized substances
similar to the prescription drugs sildenafil
and tadalafil. There was nothing on the
product labels or packaging to indicate
such ingredients.
Another retailer who manufactures and
distributes NHPs also got a recall order,

A

but refused to comply, despite the fact that
one of its nutritional shakes contained the
prescription drug chloramphenicol. Health
Canada says this is an antibiotic associated
with the risk of a potentially fatal blood
disorder.
The retailer said contamination wasnâ&#x20AC;&#x2122;t a
health risk because of low concentration in
its shakes. Nevertheless, an NHP product
for sale containing a known pharmaceutical is against the law. Enforcing the law is
something else again.

73 per cent of
Canadians regularly take
vitamins and minerals,
herbal products, and
homeopathic medicine.

Health Canada has a major challenge
because of a lack of resources. While most
players involved in the NHP industry are
ethical, there are unscrupulous retailers, manufacturers and distributors who
are less than honest with the consumer.
The industry is not subjected to audits,
and even when problems arise, the process in dealing with them is bureaucratic
and time-consuming. Also, itâ&#x20AC;&#x2122;s easy to get
around loopholes.

For example, a U.S. company shipping
product to Canada must deal with added
levels of security at the border, but if the
company establishes a manufacturing facility in Canada, the same level of security no
longer exists. The company can make what
it wants and sell it, even if the information
on the label or packaging is less than accurate.
Health Canada reacts when a complaint
is lodged, but there is very little that is
proactive in the process. Even though the
NHP world is regulated, the rules are not
enforced, giving an unfair advantage to
unscrupulous players who can make any
claims about their products.
The federal government recently announced new legislation called The Protecting Canadians from Unsafe Drugs Act.
The Act, which could become law this
year, applies to prescription and over-thecounter drugs, as well as medical devices,
vaccines, gene therapies, cells, tissues and
organs. The Act:
â&#x20AC;˘ Imposes stiff penalties for unsafe products with fines up to $5 million a day and
two years in prison for those who do not
comply with orders;
â&#x20AC;˘ Speeds up product recalls or label changes when a problem is identified; and,
â&#x20AC;˘ Increases patient safety by improving
Health Canadaâ&#x20AC;&#x2122;s ability to collect safety
information on products sold for therapeutic use.
While this legislation does not specifically address NHPs, it would deal with
those who defy a Health Canada order to

recall product found to contain a prescription drug, or a product similar to a prescription drug. Thus, a business that defies
a Health Canada recall could face severe
penalties.
A University of Guelph study published
in the journal BMC Medicine should serve
as a wake-up call about the potential dangers of some NHPs. The study used DNA
barcoding technology to test 44 herbal
products sold by 12 manufacturers, and
showed that most of the NHPs surveyed
contained fillers and plant ingredients
not listed on the label. One ginkgo product was contaminated with Juglans nigra
(black walnut), which can be fatal for anyone with a nut allergy. Almost 60 per cent
of the herbal products contained plant species not listed on the label, and more than
20 per cent included such fillers as rice,
soybeans and wheat which, again, were not
on the label.
There is virtually no enforcement of
quality control for the manufacture and labelling of Natural Health Products in Canada, and while the University of Guelph
study concluded that we need more regulations, in fact, we donâ&#x20AC;&#x2122;t. But existing regulations should be better enforced. People
who suffer from plant allergies or seek gluten-free products should not to be exposed
to these hazards because they buy NHP
H
products that are improperly labelled. â&#x2013;
Deborah A. Campbell is, an advisor to
the Natural Health Products Directorate
of Health Canada.

5HEXLOGLQJ/LYHVDQG*XDUDQWHHLQJ5HVXOWV j

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â&#x20AC;&#x153;Canadians deserve the best legal representation and
highest standard of healthcare available to them.
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David Himelfarb

Over 100 years of experience specializing in all areas of personal law
Motor Vehicle Accidents
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Taking control of pain
By Michelle Halsey
hild life specialists at Holland
Bloorview Kids Rehabilitation Hospital are empowering
young patients to take control
of their pain and helping parents develop
strategies to support their kids.
The response to pain is not simply a result of tissue or nerve damage, but rather a
combination of both physical and psychological variables. â&#x20AC;&#x153;Literature shows that
the best approach to pain management is
a blend of pharmacological and non-pharmacological interventions,â&#x20AC;? says Breanne
Mathers, child life specialist at Holland
Bloorview. â&#x20AC;&#x153;With this in mind, we create
individual plans to proactively manage
pain rather than chasing it.â&#x20AC;?
While strategies are patient-directed,
families can also play an important role
in pain management. This is especially
true when a patient has communication
challenges since parents can often recognize subtle pain indicators. Mathers
says that patients and families should not
resign themselves to a certain level of
expected pain since patients as young
as four years old can be taught pain
management strategies.

C

Successful pain
management requires
a plan that outlines
personalized goals that
can be assessed and
adjusted regularly
â&#x20AC;&#x153;Parents often report that they feel
there is nothing they can do about watching their child in pain. When parents are
taught non-pharmacological pain management techniques, they can proactively
coach their child to manage pain. Parents
are then empowered when hospital staff
is not at the bedside or when the child is
at home.â&#x20AC;?
www.hospitalnews.com

Mathers and other child life specialists
at Holland Bloorview run a group for patients and families to teach them about
pain management. Patients and families
attend 30 minute sessions to become familiar with a variety of non-pharmacological techniques to reduce acute, chronic
or recurrent pain. Session topics include
humour, multisensory environments like
Snoezelen, distraction boxes and advocacy. Feedback from the sessions shows
it has been an effective way to provide
information to patients and their families
while helping them learn how to support
each other.
Patients can experiment with a variety
of techniques to find those best suited to
their needs. Some patients may find cognitive techniques like distraction and imagery to be most effective while others may
prefer behavioural techniques like meditation or deep breathing. There are also a
range of biophysical techniques like heat
therapy and massage as well as emotional
expression strategies such as art. Once
learned, pain management strategies have
also been shown to be effective tools for
managing stress, anxiety and nausea.
Successful pain management requires a
plan that outlines personalized goals that
can be assessed and adjusted regularly.
Communication both ways between the
health care team and the patient and family is paramount to the success of the plan.
Honest explanations from clinicians about
procedures that may cause pain can go a
long way in reducing the patientâ&#x20AC;&#x2122;s anxiety.
In fact, the act of developing a plan in itself helps to minimize fear and can give patients a sense of control over the situation.
The individualized plan should also include an outline of which medications will
be used and an explanation of how each
works. Explaining to patients the type
of pain a medication will target, along
with an understanding of how it works,
will complement non-pharmacological
strategies.

Clients at Holland Bloorview generally
have stays that are long enough to trial different techniques and master skills, however, patients experiencing shorter stays
can quickly learn certain pain management techniques.
Simpler strategies like therapeutic
touch, deep breathing and management
of physical space can be implemented
with little instruction. In all cases, patients
should be encouraged to have a dialogue
about pain management rather than simply accepting pharmacological strategies as
the total plan.
Ideas for a patient distraction box:

â&#x20AC;˘Party blowers and pinwheels that
encourage deep breathing
â&#x20AC;˘Bubbles for deep-breathing and therapeutic popping
â&#x20AC;˘Squishy items like stressballs for therapeutic touch and massage
â&#x20AC;˘Toys like dinky cars can bring attention
to or away from pain area
â&#x20AC;˘CDs with calming music
â&#x20AC;˘Joke book or other items that employ humour
H
â&#x20AC;˘ Hot or cold packs â&#x2013;
Michelle Halsey is a Senior
Communications Associate at Holland
Bloorview Kids Rehabilitation Hospital.

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MARCH 2014 HOSPITAL NEWS

PAIN CONTROL/COMPLEMENTARY HEALTH/HEALTH PROMOTION

22 Focus

Solving the

pain puzzle?
By Dr. Alejandro Elorriaga Claraco
he November 2013 â&#x20AC;&#x153;Pain in
Canada fact sheetâ&#x20AC;? published
by the Canadian Pain Society
states some hard facts summarized under the heading Pain is Poorly
Managed in Canada. These facts include:
â&#x20AC;˘ Canadians are left in pain after surgery
even in our top hospitals
â&#x20AC;˘Surgery itself is the cause of almost 10
per cent of chronic pain in Canada
â&#x20AC;˘Pain is the most common reason for
seeking healthcare (78 per cent ER visits)
â&#x20AC;˘One in five Canadian adults suffer from
chronic pain
â&#x20AC;˘One in five Canadian children have
weekly or more frequent chronic pain
â&#x20AC;˘Chronic pain is associated with the
worst quality of life as compared with
other chronic diseases
â&#x20AC;˘The annual cost of chronic pain in Canada is $56-60 billion dollars
If we are [officially] practicing â&#x20AC;&#x153;Evidence-Based Medicineâ&#x20AC;? in Canada, why
is the â&#x20AC;&#x153;empirical evidenceâ&#x20AC;? presented
above showing that we are seriously failing to treat pain? One answer, based on
the hard data that shows where money
is spent in the medical systems of developed countries, is thatâ&#x20AC;Ś even though
â&#x20AC;&#x153;pain is a puzzleâ&#x20AC;? with many pieces, we
are approaching its treatment in an over-

T

simplified manner, favoring pharmacological and surgical interventions over
any other approach.
For many years, scientific knowledge
of pain has been providing new clues to
help us understand â&#x20AC;&#x153;the pain puzzle.â&#x20AC;?
Perhaps the most important scientific
fact regarding pain is that the experience
of pain is paradoxical: while pain is perceived â&#x20AC;&#x153;as ifâ&#x20AC;? occurring in the body, in
actuality, pain is the result of the brainâ&#x20AC;&#x2122;s
integration of complex neurological activity involving cognitive, affective and
sensory dimensions, what Dr. Melzack
termed years ago â&#x20AC;&#x153;the neuromatrix.â&#x20AC;? The
immediate corollary is that if â&#x20AC;&#x153;pain is in
the brainâ&#x20AC;?, there is where we need to start
solving the pain puzzle.
In addition to the brain dimensions,
there are other contributors to the â&#x20AC;&#x153;pain
puzzleâ&#x20AC;? also identified by science, such as
the peripheral nerve pathways involved
in the transmission and processing of
â&#x20AC;&#x153;unpleasant sensory informationâ&#x20AC;?, as well
as the many spinal cord processes that influence the final passage of these signals
to the brain.
As a reflection of its phenomenal complexity, the physiology of the pain experience involves all our important levels of
function: neurological, metabolic, hor-

monal, immune, visceral, biomechanical
and psycho-emotional.
With this picture, itâ&#x20AC;&#x2122;s not surprising
that chronic pain research has proven
the most effective approach to the management of pain is the bio-psycho-social
model. This model proposes that health
is best understood in terms of a combination of biological, psychological, and
social factors rather than purely in biological terms.
Why then are we are still treating
pain in daily practice armed mainly with
pills, injections and surgical scalps? Well,
that is a $60 billion dollar question for
Canadians ($600 billion for the USA).

The answer? Self evident: consumers of
healthcare are extremely naĂŻve expecting that a system dominated by multibillion dollars interests (pharmaceuticals,
diagnostics, etc.) would care to change
a working model that produces phenomenal profits year after year. Really?
Well, ponder this undeniable fact,
based on hard cold data from the Organisation for Economic Co-operation and
Development: pharmaceutical expenditure and diagnostics are bankrupting the
medical systems of developed countries
without providing any additional value
to our health.
Continued on page 31

s parents, we want our children to eat a well-balanced
and healthy diet, but when
your child doesnâ&#x20AC;&#x2122;t eat his or
her vegetables or more than a few selected
food items â&#x20AC;&#x201C; ensuring your childâ&#x20AC;&#x2122;s growth
can become a constant cause for concern.
A feeding disorder is defined as a child or
infant who has the inability to take in nutrition in order to meet their needs. For
some children the smell and texture of food
causes them significant distress which can
lead to low growth rates and serious health
issues or a failure to thrive diagnosis.
Since 2009, the Peterborough Regional
Health Centreâ&#x20AC;&#x2122;s (PRHC) Family and Youth
Clinic has offered a focused intervention
for young children and their families dealing with significant food refusal. More recently the service has been a collaborative
partnership between the hospitalâ&#x20AC;&#x2122;s Family and Youth, and Paediatric Outpatient
Clinic. The clinic treats approximately 60
patients per year for feeding disorders and
sees another 60 patients for picky or selective eating concerns.
Most have said or heard the classic
mealtime tug of war â&#x20AC;&#x2DC;you canâ&#x20AC;&#x2122;t leave the
table until you finish your dinnerâ&#x20AC;&#x2122;, but this
tactic can actually cause more harm than
good for children with feeding disorders.
â&#x20AC;&#x153;Negative mealtime experiences can be
a trigger for children who struggle to eat
enough to stay healthy,â&#x20AC;? says Lise Leahy,
Registered Dietitian at PRHCâ&#x20AC;&#x2122;s Pediatric
Outpatient Clinic and Feeding Disorders
Clinic. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s hard to feel hungry when you
are stressed because itâ&#x20AC;&#x2122;s time to eat.â&#x20AC;?
The teamâ&#x20AC;&#x2122;s multidisciplinary assessment
includes psychology, nutrition, social work
and medical providers. The first appointment focuses on getting to know the family and child. â&#x20AC;&#x153;Our goal is to listen to the
familyâ&#x20AC;&#x2122;s story and learn when the problems
emerged, what the child eats or doesnâ&#x20AC;&#x2122;t,
is there a time of day they eat more, and
review the child or infantâ&#x20AC;&#x2122;s growth and
development,â&#x20AC;? explains Connie Oates,
Psychological Associate at PRHCâ&#x20AC;&#x2122;s Family
and Youth Clinic.
The clinicâ&#x20AC;&#x2122;s family based approach takes
a holistic view of the infant or child. The
clinicâ&#x20AC;&#x2122;s team carefully considers all issues
that may interfere with healthy eating and
contribute to the disorder such as medical
complications, hypersensitivities, atypical neurodevelopment such as Autism,
stress around feeding or food, anxiety in
child or caregiver or gastroesophageal reflux disease(GERD). â&#x20AC;&#x153;Our first task is to
remove stress at meal time,â&#x20AC;? says Leahy.
â&#x20AC;&#x153;Through coaching, we teach parents to
reduce their own level of stress through
deep breaths and positive statements.
Once parents believe that their child will
eat and that they have a role in helping, we
are well on the way to creating a positive
meal time experience.â&#x20AC;?
For example if you are making a stir fry
for the family and your child will only eat
bread and cheese, then make sure that
bread and cheese are on the table for the
child to select. â&#x20AC;&#x153;If the bread and cheese are
the only items your child eats in a nonstressed situation then it was a positive
and successful interaction,â&#x20AC;? adds Leahy.

A

www.hospitalnews.com

Tammara Howting (left) and daughter Evelyn Howting enjoy a cookie thanks to the help of Peterborough Regional Health
Centre's Feeding Disorders Clinic.
The child was also exposed to the sight
and smell of a stir fry and watched other
people enjoy it.
For the Howting family, this advice
was instrumental in their 13-month-old
daughter Evelynâ&#x20AC;&#x2122;s success. Evelyn was six
weeks old when she was diagnosed with a
slow rate of growth. After numerous appointments it was determined that there
was nothing physically wrong with her â&#x20AC;&#x201C;
Evelyn continued to eat, but growth was
slow.

A feeding disorder is
defined as a child or infant
who has the inability to
take in nutrition in order
to meet their needs.
Then in October 2013, Evelyn came
down with the flu and high fever and refused to eat. â&#x20AC;&#x153;Evelyn stopped going into
her high chair, or sleeping in her crib,â&#x20AC;? says
Tammara Howting, Evelynâ&#x20AC;&#x2122;s mother. â&#x20AC;&#x153;We
went to Emergency, but after a week of no
sleep and little feeding â&#x20AC;&#x201C; it was clear that
we needed help.â&#x20AC;?
In November, the Howting family was
referred to PRHCâ&#x20AC;&#x2122;s Feeding Disorder
clinic. After gathering Evelynâ&#x20AC;&#x2122;s story, clinic
staff members determined that Evelynâ&#x20AC;&#x2122;s illness caused stomach pain which contributed to Evelynâ&#x20AC;&#x2122;s refusal to eat and sleep.
For Evelyn, she associated her stomach
pain to eating in her highchair and sleeping in her crib. â&#x20AC;&#x153;Connie and Lise taught us
to give Evelyn foods that she always liked
eating,â&#x20AC;? notes Howting. â&#x20AC;&#x153;We now give her
a â&#x20AC;&#x2DC;mumâ&#x20AC;&#x2122;s cookieâ&#x20AC;&#x2122; on her highchair to signal
that itâ&#x20AC;&#x2122;s time to eat and Evelyn now sits
in her chair again.â&#x20AC;? After three months of
clinic appointments, Tammara and Evelyn
are seeing progress. â&#x20AC;&#x153;Evelyn now sleeps in
her crib again,â&#x20AC;? says Howting. â&#x20AC;&#x153;Another
strategy the clinic taught us was to never
leave her bedroom when she was upset.
This teaches Evelyn that her room is a
happy and safe place.â&#x20AC;?

Now at 16.5 lbs, Evelyn is still small for
her age, but the Howting family has tools
and strategies to help their daughter grow.
â&#x20AC;&#x153;We still get the odd â&#x20AC;&#x2DC;your child weighs
how much commentâ&#x20AC;&#x2122;, but itâ&#x20AC;&#x2122;s wonderful
to know we have people on our team supporting us,â&#x20AC;? says Howting. â&#x20AC;&#x153;PRHCâ&#x20AC;&#x2122;s Feeding Disorders Clinic provides compassionate care â&#x20AC;&#x201C; in the beginning they met with
us weekly, answered all our questions, and
reassured us that we were not to blame for
Evelynâ&#x20AC;&#x2122;s slow growth.â&#x20AC;?
Another strategy used at the clinic involves parents packing a picnic or snack to
bring to their second appointment made
up of food that their child usually eats.
â&#x20AC;&#x153;With the parentsâ&#x20AC;&#x2122; permission we video
tape these sessions, and use the footage
to identify opportunities and tactics to use
when trying to introduce a new food or
getting a child to eat more of the same food
that he/she enjoys,â&#x20AC;? notes Leahy.
â&#x20AC;&#x153;One of the biggest challenges facing families attending the clinic is that
change will not happen overnight,â&#x20AC;? adds
Oates. â&#x20AC;&#x153;The ongoing medical monitoring
of growth and liaison with the infant or
childâ&#x20AC;&#x2122;s physician is a key to easing parental
anxiety. Families are encouraged to keep a
mealtime journal and document informa-

tion like what mealtime was easier than
others, what worked well, what your child
ate, touched, or smelled.â&#x20AC;?
Itâ&#x20AC;&#x2122;s important to remember that children are curious by nature and will start
to show signs that they are interested in
other types of food. Parents are encouraged
to provide opportunities for their child to
interact with food such as going to the
grocery store, helping to prepare snacks,
growing a garden or even using food for art
projects. Listen for key phases such as â&#x20AC;&#x2DC;that
smells good or what is it?â&#x20AC;&#x2122; and watch for
your child noticing where you place food
during meals to gauge his/her interest and
reaction.
If you think your child has a feeding disorder or if you have concerns regarding his/
her picky or selective eating habits, speak
to your family doctor or Nurse Practitioner. Some symptoms to look for include
highly restrictive food choices, significant
conflict involving meal times or feeding,
frequent refusal to approach the table for
meals, gastrointestinal distress, and failure
H
to grow or slow growth rate. â&#x2013;
Amanda Roffey is a Communications
Advisor at Peterborough Regional
Health Centre.

service excellence
By Matthew Anderson
ike every other hospital across
the province, William Osler
Health System (Osler) is continuously striving to make life
better for patients and their families. With
thousands of patients walking through our
doors each and every day, we are steadfastly committed to ensuring that each and
every one of them has positive interactions
with our staff, physicians and volunteers.
I think my hospital colleagues would
agree that while this sounds like a reasonable goal, it is unbelievably challenging to
put into practice. A negative impression
can be formed even if the care that was
provided at the bedside during a stay was
excellent. This impression may form in any
number of places away from the inpatient
floor – locations like the parking lot, the
cafeteria, or even in the elevator. These
impressions can also be extremely difficult to identify and address if mechanisms
aren’t in place to capture the information.
As one of Ontario’s largest hospitals, we
serve a population of over 1.3 million people living in one of the fastest growing and
most culturally diverse regions in Canada.
Osler’s emergency departments (ED) are
among the busiest in the province and our
labour and delivery program is one of the
largest in Ontario.

L

With our growing and diverse community always top of mind, we have made service excellence a key driver behind everything we do. At Osler, service excellence
represents the softer side of healthcare –
the human touch that makes a significant
difference to patients and families during a
hospital stay. Service excellence was made
a significant component of our 2013-2018
Strategic Plan and called out as our first
strategic direction – stating that we will
improve how we communicate with patients and families, listen to what they are
telling us, and take action so that we can
better serve their needs.
Long before the launch of our Strategic
Plan and following a period of time when
patient satisfaction scores were at an alltime low, Osler identified the need for
more timely information about a patient’s
stay in order to better understand where it
needed to improve – and to then be able to
feed that information back to our clinical
units for quick action.
Recognizing the tremendous opportunity to make a difference for our patients
and their families, we launched a ‘Service Excellence Call Centre’ in 2011 that
conducts outbound calls to inpatients 48
hours after discharge for the purpose of
gathering feedback on their hospital stay.

The call centre is staffed by modified workers (nurses who may need to be off their
feet), college students (who need practicum hours to complete their diplomas)
and volunteers, and is able to collect rich
feedback through what we like to call, ‘the
voice of the patient’.
Over the course of the call, patients are
asked a few short questions about their
satisfaction with their stay, if they were
treated with respect and dignity, if they
would recommend the hospital to family
and friends, and if they have any suggestions for ways we could improve. All comments are immediately documented and
stored within a secured hospital database.

Osler launched a ‘Service
Excellence Call Centre’
in 2011 that conducts
outbound calls to
inpatients 48 hours after
discharge for the purpose
of gathering feedback on
their hospital stay.

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This feedback is then shared with hospital staff on the front-lines where it is
used immediately to help us better understand and evaluate each patient’s experience, celebrate success stories and identify
where staff and physicians can focus their
energies to further improve the patient
experience.
With establishment of the call centre, we soon recognized that we needed a
means of feeding information back to the
front-lines where it could be used immediately to influence behaviours and improvement strategies. As a result, we implemented daily ‘performance huddles’ across
all clinical areas in the hospital in early
2012. These huddles are short, 10-minute
sessions where managers and front-line
staff come together to discuss their performance against four key metrics.

It has also been extremely effective in
identifying outstanding services and giving
us an opportunity to recognize good work.
The ability to immediately collaborate on
solutions and share patient stories has positively influenced staff satisfaction. Recent
survey results show a 10 per cent improvement year over year.
In just three years, our call centre has
provided us with more robust knowledge
to better inform the care we deliver, impact decision-making, identify areas for
improvements, and acknowledge our highperforming areas. Given the diversity of
our community, it also helps to ensure that
we continue to deliver quality care that
respects the traditions, religion and culture
of our patients and their families.
With such a diverse community, we incorporate our interpretation services program into the operations of the call centre
to ensure staff are able to communication
effectively with every patient. A number
of call centre staff are also multi-lingual,
so they are encouraged to speak in different languages to ensure we are being as
inclusive as possible.
Some of our successes to date have
come in the form of an award from
Accreditation Canada and even national
and international attention with requests
to speak about our call centre and service excellence program at a number of
conferences. In April, we will be presenting at the Beryl Institute’s Patient Experience Conference, and in May, we will be
speaking at the Cleveland Clinic’s Patient
Experience Summit.
While it’s safe to say we still have some
work to do on improving the patient experience, we are enthusiastic that the tools
we have put in place will guide us on this
H
journey. ■
Matthew Anderson is the President and
CEO of William Osler Health System –
comprised of Brampton Civic Hospital,
Etobicoke General Hospital and the
new Peel Memorial Centre for
Integrated Health and Wellness.
www.hospitalnews.com

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www.hospitalnews.com

MARCH 2014 HOSPITAL NEWS

PAIN CONTROL/COMPLEMENTARY HEALTH/HEALTH PROMOTION

26 Focus

Falls prevention program
aims to empower those at risk
By Catherine Pringle
orothy Masih was visiting Trillium Health Partners for a routine appointment when she
suffered a fall walking through
the hospital corridors. She was quickly assisted by a hospital volunteer and taken to
the emergency department where she was
screened by the attending physician who
determined that she was at risk for future
falls. Her name was then entered into a database as part of Trillium Health Partners’
falls prevention strategy.

D

According to a report
from the Ontario
Injury Prevention
Resource Centre,
falls are the second
leading cause of
injury-related
hospitalizations
for all ages
Dorothy was treated for cuts and bruises
suffered in her fall, and released. A few
weeks later, Dorothy received a phone call
asking if she would be interested in coming to the hospital to take part in a falls
prevention program where she and other
participants would learn how to better protect themselves from another painful fall.
Dorothy agreed, and says what she gained
from that clinic has changed her life.
According to a report from the Ontario
Injury Prevention Resource Centre, falls
are the second leading cause of injury-related hospitalizations for all ages. Seniors
65 and older are nine times more likely to
suffer fall injuries than younger persons.

Sabina Sobota, rehabilitation assistant, Trillium Health Partners
with Viscilsa Alexander.
Falls are a huge problem. They can be life
altering for many people and in the worst
cases can result in death. Falls often result
in psychological harm. Victims become
frightened of falling again and as a result
limit activities, which can lead to other issues, such as isolation and immobility issues. The fact of the matter is that falls are
often preventable.
Understanding this reality, Trillium
Heath Partners recognized an opportunity to promote health and safety within
the community by helping to prevent falls
for those who are particularly prone to

At some point,
everyone can
use a hand.

Photo Sandra Tavares

them. While there had always been a falls
prevention strategy in place, there was a
chance to really address this problem in a
more strategic manner.
The new program is an initiative of the
internationally-recognized Best Practice
Guideline in falls prevention, which the
hospital has committed to achieving as
part of its candidacy for the Registered
Nurses Association of Ontario’s (RNAO)
Best Practice Spotlight Organizations
(BPSO) designation.
“Our fall rate was above where we wanted to it to be so we were very driven to

When your future is at stake,
call us at 519-438-4981,
1-877-995-3066 or
online at judithhull.com
.YHMXL,YPP
%WWSGMaXIW4VSfIWWMSREP'SrTSration

HOSPITAL NEWS MARCH 2014

reduce it and improve outcomes for patients,” says Chris Zettler, Manager, Professional Practice Portfolio,Trillium Health
Partners. “In addition to that, we have a
large seniors’ population in our community
so it was important for us to create programs that addressed their needs.”
The hospital introduced a post-fall huddle across all sites for in- and out-patients.
This tool promotes team discussion and
analysis of the event in an effort to prevent
it from happening again. The hospital implemented a trial use of low beds to prevent
injuries in patients who are prone to repeat
falls. A number of visual cues are also now
in use, including screening information
that appears on status and electronic white
boards, as well as “fall precaution” stickers
on patients’ armbands, charts alert sheets
and other relevant areas.
Trillium Health Partners has also begun
screening out-patients at registration to
identify whether or not they are at high
risk for falls. If patients are at risk staff will
make sure they have the proper assistance
from volunteer escorts while visiting the
hospital and will follow up with them once
they are home to see if they are interested
in participating in a falls prevention clinic.
While the initiative is nurse-led and
driven, Trillium Health Partners broadened the program to include all allied
health staff, physicians and volunteers
from across the organization; it is a truly
interdisciplinary approach.
“It takes a village,” says Zettler. “Our
professional service team attains information from our patients in order to assess
whether or not they are prone to falls, our
volunteers utilize wheelchairs set up by
their stations to help patients get from one
part of the hospital to another and our porters help get patients and their information
from one unit to another.”
Trillium Health Partners’ goal for the inpatient program is to achieve the industry
standard of four falls per thousand patient
days. For our outpatient program, we really
wanted to see a reduction in the number of
falls and fall-related injuries while people
are visiting our facilities.
Trillium Health Partners has experienced great success with a number of its
falls prevention tactics. The trial use of low
beds resulted in an 80 per cent reduction of
falls and there were no injuries for the patients who used low beds. Furthermore, the
implementation of visual cues has played
a significant role in raising awareness
amongst staff, physicians and volunteers.
“We are very pleased with our progress
to date. The falls prevention strategy has
increased the overall awareness of falls and
the need to prevent them both within the
hospital and outside its walls,” says Zettler.
“As a result of this program and the efforts of all those involved, we have seen
our inpatient fall rates decrease steadily.
The outpatient program is a more recent
initiative and we are continuing to monitor the data on a quarterly basis but we are
encouraged by the preliminary results for
H
people like Dorothy.” ■
Catherine Pringle is a Senior
Communications Advisor at
Trillium Health Partners.
www.hospitalnews.com

PAIN CONTROL/COMPLEMENTARY HEALTH/HEALTH PROMOTION

Focus 27

Acupuncture
turns addict into a believer
By Donna Danyluk
d Dowdell can’t remember
a time when he wasn’t on
something.
He started drinking at the
age of seven and then added drugs into the
mix as a young adult. His life was a vicious
cycle of abuse and addictions. The addictions helped numb the pain of his Post-Traumatic Stress Disorder (PTSD), but caused
his mind to race and his hands to shake.
Sleeping was never easy and relaxing was
out of the question. He became a workaholic – a man always running at full speed.
And so when his addictions counselor
at Barrie’s Royal Victoria Regional Health
Centre (RVH) suggested he try acupuncture as a way to relax, he just had to laugh.
“I thought it would be a waste of time. I
actually thought it was joke. I was so skeptical,” says Dowdell.
And so with his arms crossed and a
scowl on his face, the 51-year-old Barrie man sat against the wall in the group
therapy room. He didn’t really want to be
there, but he had no place else to be, so the
frowning cynic stayed. And all it took was
one session to make a believer out of this
‘Doubting Thomas’.

E

“Once Brian put the music on, and put
the acupuncture needles in my ear, I shut
my mouth, put my head back, closed my
eyes and for the first time in as long as I can
remember I relaxed,” says Dowdell. “I have
never felt so at peace. I felt like I was floating down a river - so safe and calm. That
night I had the best sleep in 36 years.”
Dowdell was among the first group of
patients at RVH to be offered auricular
acupuncture as an alternative therapy for
addictions or mental health issues. The
service began in May 2013 and since then
almost 1,700 such therapies have been
administered in RVH’s Inpatient Mental
Health program. The program has been
so successful that an additional five staff
members have been trained to deliver acupuncture treatments.
“Adding an alternative therapy, such
as acupuncture, into a client’s treatment
plan is part of RVH’s ongoing commitment to deliver safe, quality, patient-centred care with a focus on individualized
treatment plans that best meet the unique
needs of our clients,” says Chris Nichols,
manager, Mental Health and Addiction
Services. “This alternative therapy is an

‘Hospital Spam’
an Oxymoron?
Not according to the new
Canadian Anti-Spam Law
By Patricia North, LL.B., LL.M.
ver the next three years, new
Canadian law will come into
force regulating commercial
electronic messaging (CEM).
Known as Canada’s Anti-Spam Legislation (CASL), and widely considered the
toughest law of its kind in the world, it
will require express or implied consent to
email and other electronic communications caught by the law’s broad definition
of ‘commercial’ unless they fit within one
of the law’s specific exceptions. Unfortunately, the definition of CEM casts a very
wide net: electronic messaging is considered commercial if one of its purposes is “to
encourage participation in a commercial
activity”. Commercial activity includes
transactions, acts or conduct of a “commercial character” regardless of whether
making a profit is the expectation. Making hospitals spend scarce public resources
to comply with CASL given their trivial
contribution to the propagation of spam
is akin to using a sledgehammer to crack
a nut. However, despite this seemingly
obvious fact, hospitals are not exempt from
this law.

O

Application to hospitals
In order to apply CASL to the health
care context, hospitals must look at their
email traffic and consider whether electronic communications are commercial in
www.hospitalnews.com

nature. While hospitals might expect that
revenue-generating activities would be
caught by CASL, one would have hoped
that the regulator would at least acknowledge, ideally in writing, that core activities
of hospitals (i.e. the provision of health
care services) are not commercial, as was
done with the federal privacy legislation.
Without such direction, hospitals are left
to grapple with such questions as whether
electronic messaging relating to uninsured
services and products or programs offered
to patients for a fee would be considered
commercial. Similarly, would electronic
messaging relating to pharmacy sales or
the leasing of space to Canada’s favorite
coffee franchise be considered commercial in nature? If the electronic messaging
is determined to be commercial, does it fit
within one of the exemptions or implied
consent provisions (which are detailed
and specific) or will express consent be required? Note that even if there is implied
consent under CASL, certain form and
content requirements may apply.
The range of electronic communications sent by hospitals is incredibly broad
and diverse, including everything from
communication with patients and other
health care providers, to research institutes and academic partners, vendors and
other commercial entities.
Continued on page 31

Ed Dowdall was one of first patients at Royal Victoria Regional Health Centre to be
offered auricular acupuncture as an alternative therapy for addictions or mental
health issues.
innovative practice in an inpatient setting. It promotes a holistic approach to
recovery and teaches patients techniques
for relaxation, other than substance or
prescription medication.”
According to Nichols, more than 75
per cent of RVH mental health clients
suffer from both addiction and mental illness, which are chronic in nature and can
be very debilitating. “That is why it is so
important to teach people how to manage
their symptoms with more natural methods and ones they can do at home or at
work,” says Nichols.
Brian Irving, RVH addictions counselor, has witnessed first-hand the benefit
of using acupuncture. “People find it very
calming and are more open and relaxed.
Acupuncture is a way to build trust with
clients who, after the treatment, are more
willing to open up and talk about their
other issues during counseling,” says Irving. “I know many people view acupuncture as holistic, but it is actually very
complementary to modern science. Acupuncture won’t cure anyone, but it can
ease the symptoms of substance use, withdrawal and various mental health issues,
including depression, anxiety and PTSD.”
Typically, an acupuncture session at
RVH is done in a group setting. Irving
inserts five needles in the ears of each

client, dims the lights, puts on calming
music and lets the group relax. Acupuncture is being utilized in RVH’s inpatient
mental health unit, the outpatient mental
health program and more recently it has
been offered to patients in the withdrawal
management program and 21-Day residential treatment program.
“Part of the purpose of acupuncture
is to learn to relax. When people are
stressed they sometimes turn to addictive
behaviours as a way to escape and cope,”
says Irving.
Dowdell knows all about that. “I was
tense all the time and when I first came
here my hands were shaking so badly I
couldn’t hold a glass. My mind was racing so fast I couldn’t think straight,” says
Dowdell. “It has calmed me down – I’ve
never felt this way before. I couldn’t wait
for the next session.”
Dowdell has since been discharged
from RVH to a community-based 90-day
treatment program where he is looking
forward to cleaning up and get back to enjoying his family. “I’m definitely a believer now. And I hate needles – really do,”
H
he laughs. ■
Donna Danyluk works in
communications at Royal Victoria
Regional Health Centre in Barrie.

he health care industry has
been more cautious in adapting new technology trends
than other sectors, and rightly
so. Personal health information must be
confidential and secure, and is closely governed by regulation – PIPEDA in Canada.
Any changes to how this information is
stored, secured or shared would likely require regulatory revision. Further, the accuracy and authenticity of information
used by health care professionals in treating a patient is literally a matter of life and
death. When so much is at stake, it is clear
why the medical community is slow to
change and still relies heavily on handwritten notes and documents.
Nonetheless, healthcare has reached
a tipping point in terms of adapting new
technology. The mobile revolution continues, and patient involvement in their own
treatment is an unstoppable force. There
is tremendous pressure on health care facilities to improve not only patient health
and wellbeing, but also the caregiver experience. The opportunity to improve patient outcomes while reducing wait times
and lowering costs to the system – in
other words, to enhance the productivity
of health care delivery – is so great that
adaptation of the enabling technology is
inevitable.
Here are five trends that will continue
to impact the health care industry in 2014
and beyond.

T

1. BYOD is
becoming mainstream
Employees today want to be connected
to everything, and increasingly they want
that connectivity on their personal mobile
devices. Faced with an influx of personal
smartphones and tablets brought to work
by their medical staff, hospitals are beginning to embrace the BYOD (Bring Your
Own Device) trend and are looking at the
support requirements and protocols needed to manage confidentiality and privacy
requirements.
Does your hospital have a BYOD policy
that includes an enabling IT infrastructure, and governance and compliance issues? The good news is that there are now
tools available to securely support the
multitude of mobile devices your staff are
already bringing to work.
The return on investment for BYOD in
a hospital setting is still not easy to compute, but the payoff in terms of employee
satisfaction and the potential for productivity gains in delivering patient care can
no longer be ignored. BYOD is here to stay,
and 2014 may be the year to fully embrace
it.

2. Big Data plays a
vital role in patient care
With advanced technologies, we are
now able to analyze and retrieve valuable
information from collections of large and
complex data sets (known as “Big Data”)
that until recently were too difficult to process with traditional data processing appliHOSPITAL NEWS MARCH 2014

cations. In the health care world, this is a
huge benefit for individual patient care,
research into diseases, and overall productivity in the delivery of services.
As Electronic Health Records evolve
and are capable of working with outside
apps, critical information is being captured
and recorded by both caregivers and patients themselves. Data from all sources
needs to be integrated to provide a holistic
view of patient diagnosis and treatment.
Patients can also access their information
from almost any device at any location.

Personal health
information must be
confidential and secure,
and is closely governed
by regulation
With this new capability to manage and
analyze Big Data, and the reality that information is increasingly being stored on
and retrieved from mobile devices, the era
of Big Data in patient care has arrived.
Access to comprehensive health data
enables more accurate prognosis and treatment decisions. Health care providers are
realizing the benefit of Big Data to
deliver better care at lower costs as well
as more customized treatment plans.

EHR systems have become more affordable and information can be exchanged
more easily than ever before.

3. Telemedicine will
deliver cost-effective
care for the future
Technology is continuing to push the envelope of treatment options available to all
patients. With video conferencing through
laptops, smartphones and tablets, patients
can easily connect with their medical staff.
Self-monitoring devices make it easier for
patients to monitor and report their vital
signs without a trip to the doctor or hospital. Post hospitalization, patients can check
in and upload their data, and medical staff
can videoconference with the patient or
with other members of their team.
Such ‘virtual’ care will continue to increase through 2014 and beyond.

4. Data security
solutions are at hand
Personal health information must always
be encrypted, and ensuring patient confidentiality and compliance with regulatory
requirements has become more challenging as the IT environment becomes increasingly complex. At the same time, the
platforms that provide data security continue to evolve to meet these challenges.
A great backup tool is the ability to
track and erase information from devices
that have been stolen or compromised.

This security solution is now readily avail
able, as well as products that provide secure leads for email, texting, file sharing
and videoconferencing.

5. Mobile apps
are on the rise
Medical staff access mobile apps to
quickly gather many types of information.
Patients use mobile apps to count their calorie intake or measure heart rate, to assist
with more complex regimens like managing chronic disease, or to be reminded to
take their medication.
EHRs are also evolving to work better
with outside apps for data input and monitoring. Health systems are developing and
implementing their own apps to help improve the patient experience. Finally, apps
are being developed to span many different
devices, and will play a vital role in healthcare now and in the future.
Technology continues to develop at a
dramatic pace. Tablets, servers, cloud computing, smart machines and smart printers
will all encourage a major work shift – and
less use of paper – in hospitals and medical facilities throughout the world. The
potential for new technologies to improve
patient outcomes while reducing costs is
H
swiftly becoming a reality. ■
Ken Jarvis is Healthcare Industry
Practice Manager, Printing Personal
Systems-Americas, HP.

Electronic record transforms care
By Stefanie Kreibe
hen treating patients requiring
mental healthcare, caregivers
need compassion, understanding and quick, complete and
accurate access to previous treatment and
health records.
“Time is of the essence,” says Thomas
Jones, Manager of the Mental Health Program at Mackenzie Health. He knows that
medical decisions on how best to treat a
patient need must be made quickly and
correctly. If a patient comes into the hospital in need of urgent mental health care,
having the most up-to-date information
can help staff make clear and informed
care decisions.
Until this past July, staff treating mental
health patients in the Emergency Department and other outpatient clinics faced a
number of challenges in accessing patient
histories in an efficient and timely manner,
Mr. Jones says.
“Up until that time, if a patient came to
the Emergency Department in crisis, his or
her complete mental health record was not
always readily available,” he says.
To overcome these challenges, Mackenzie Health in Richmond Hill, Ontario
and Southlake Regional Health Centre
in nearby Newmarket, collaborated to
improve care for patients seeking mental

W

Photo Jim Craigmyle

Melissa Petriglia, and Thomas Jones,
use the new single electronic mental
health record.
health services at the hospitals with a new
Ambulatory Electronic Mental Health Record (AEMHR). This software, provided
by B Sharp Technologies and McKesson
Canada is enabling the hospitals to create,
view and update existing mental health
records for patients in real time, providing
instant access to previous records and better coordination and integration of care for
adult mental health encounters.
With funding from Canada Health Infoway, the system gives mental health professionals from both facilities secure access
to their patients’ entire inpatient and out-

patient encounter history within their hospital network, providing seamless mental
healthcare across the entire organization.
The new AEMHR is improving access
to information for more than 200 clinicians resulting in improved care for thousands of patients at Mackenzie Health and
Southlake. The system went live at Mackenzie Health in July 2013 and Southlake
Regional Health Centre in November
2013 providing enhanced care for patients
who visit outpatient clinics and improve
safety for those receiving prescriptions for
mental health.
In addition, as part of this project, patient assessments are being sent to the
provincial Integrated Assessment Record
(IAR) Portal using the B Care Mental
Health Solution, so other authorized clinicians involved in patient care can access
appropriate information to optimize care
coordination and treatment.
With this innovative approach, Mackenzie Health and Southlake are working
together to help simplify the journey that
many mental health patients face by creating a comprehensive record that more effectively communicates their story, in the
H
event the patient cannot. ■
Stefanie Kreibe is a Consultant in
Communications and Public Affairs
at Mackenzie Health.
www.hospitalnews.com

Tele-mentoring
brings specialists
close to home

Healthcare Technology 29

By Donna Faye

hen a migraine brought Sara
Hampel to Thunder Bay Regional Health Sciences Centre
(TBRHSC) earlier this year,
she had no idea that she would have access to one of the countryâ&#x20AC;&#x2122;s leading neurosurgeons, based in Toronto, without even
stepping into an airplane.
Thunder Bay neurosurgeon Dr. Stephen McCluskey saw Hampel and recommended a minimally invasive surgery
for the treatment of hydrocephalus called
Endoscopic Third Ventriculostomy (ETV).
In an ETV, the surgeon uses a small video
camera to â&#x20AC;&#x153;seeâ&#x20AC;? inside the brain and makes
a hole in the bottom of one of the ventricles or between the ventricles to enable
cerebrospinal fluid to flow out of the brain.
â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s not appropriate for everyone but
she was an excellent candidate for ETV,â&#x20AC;?
says Dr. McCluskey. The only obstacle â&#x20AC;&#x201C; a
significant one â&#x20AC;&#x201C; was accessing the necessary equipment. Dr. McCluskey was able
to rent the equipment, which took several
weeks to arrive. Because he had not had
access to a ventriloscope for a number of
years, Dr. McCluskey had also not performed an ETV since his training. For that
reason, he wanted an expert present during the operation. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s always good to have
mentoring when you havenâ&#x20AC;&#x2122;t performed a
specific procedure in a long time,â&#x20AC;? he says.
He contacted Dr. James Drake, a neurosurgeon in the Division of Paediatric Neurosurgery at the Hospital for Sick Children
(SickKids) in Toronto and an expert in the
science and surgery of hydrocephalus. Dr.
Drake agreed to be present via Telemedicine.
TBRHSCâ&#x20AC;&#x2122;s Telemedicine Department
worked to make sure the connection with
SickKids would work and then scheduled
the surgery via the Ontario Telemedicine
Network, with a studio at SickKids and
the TBRHSCâ&#x20AC;&#x2122;s Operating Room, which is
equipped with Telemedicine cameras that
allow off-site surgeons and/or students to
see the surgery.
Dr. McCluskey says that the operation
went very smoothly under Dr. Drakeâ&#x20AC;&#x2122;s telementoring. â&#x20AC;&#x153;As a physician, itâ&#x20AC;&#x2122;s very satisfying to be able to provide that service,
rather than send a patient to Winnipeg or
Toronto,â&#x20AC;? says Dr. McCluskey. â&#x20AC;&#x153;Eventually
we would do this without mentoring.â&#x20AC;?
Hampel says she feels great and was glad
she didnâ&#x20AC;&#x2122;t have to travel to Toronto. â&#x20AC;&#x153;Telementoring is wonderful for people living
in isolated communities like Thunder Bay
and other towns in Northwestern Ontario.
I think itâ&#x20AC;&#x2122;s wonderful that we have technology that allows us to access out-of-town
specialists.â&#x20AC;?
Trina Diner, Manager of Palliative Care
and Telemedicine, says there are plenty of
opportunities for health care providers,
including physicians, dietitians, pharmacists, social workers to take advantage of
Telemedicine. â&#x20AC;&#x153;Even if the appointment
or consult is only 15 minutes, we can reduce stress for patients and families having to take time off work to travel. This

W

www.hospitalnews.com

saves time and money, as well as separation from their support network of family
H
and friends.â&#x20AC;? â&#x2013;
Donna Faye works in communications
at Thunder Bay Regional Health
Sciences Centre

I think itâ&#x20AC;&#x2122;s wonderful that we have technology that allows us to access out-of-town
specialists,â&#x20AC;? says Sara Hampel (centre), seen here with Telemedicine Nurse, Karen
McPhail (left) and Director of Supportive Care and Cancer Care, Dr. Scott Sellick (right).

â&#x20AC;&#x153; Focus on the things you can do, not
ZKDW\RXFDQĂ&#x2013;WDQG\RXZLOOĂ&#x;QG
just like I did, that life is fantastic.â&#x20AC;?
â&#x20AC;&#x201C; Danny McCoy

Danny McCoy was rendered a paraplegic in a terrible car accident at the age of 43.
Before the accident he was an avid sailor. After the accident, Danny became one of the
top ranked competitive disabled sailors in the world. Heâ&#x20AC;&#x2122;s also the founder of the Disabled
Sailing Association of Ontario and one of the sportâ&#x20AC;&#x2122;s foremost international ambassadors.
Thomson, Rogers is a proud supporter of The Disabled Sailing Association of Ontario.
We are honoured to have represented Danny McCoy in his lawsuit and to count Danny
as a friend and one of the many everyday heroes we have been able to help.

We try to list all events and information but due to space constraints and
demand, we cannot guarantee it. To promote your event in a larger, customized
format please send enquiries to “advertising@hospitalnews.com”

Q March 5, 2014
Islamic perspectives on End-of-Life Issues and Death
University of St.Michael’s College, Toronto
Website: www.ccbi-utoronto.ca

Crete, a large island in Greece offers pretty much anything a traveller could wish for.

Greek island
hopping in style
By Victoria Brenner
y heart tells me that I WANT
adventure but my head tells
me I NEED clean bedding,
comfy pillows and a good
night’s sleep. Where is that perfect balance
between living life a little more fully and
enjoying the comforts of life that make the
experience enjoyable?
Island hopping around the Greek Islands
is for me that perfect balance between the
two – the thrill of exploring new places and
meeting new people while enjoying some
of the best quality accommodation and
food in the beautiful Mediterranean.
When deciding on a route, a good map
of the ferry routes is essential. Remember
that in high summer there are many extra
routes and scheduled ferries running.

M

One thing not to miss
before leaving Mykonos
is a day trip to
neighbouring Delos,
the ‘Island of the Gods’
If you are starting from Athens then
head down to the ferry port at Piraeus harbour and hop on a boat headed for Mykonos – a large island with a great history,
a warm welcome for visitors and some of
the finest bays and beaches in Europe. The
Mykonos Blu resort is a definite star choice
for somewhere to stay if you want to ease
into your Greek adventure with some real
first class pampering.
A few days exploring the island or zoning out on the beaches of the impossibly
pretty Psarou bay may be all you need before the wanderlust kicks in. One thing not
to miss before leaving Mykonos is a day trip
to neighbouring Delos, the ‘Island of the
Gods’. This was a cult centre and pilgrimage site in Classical times. Rules imposed
on earlier visitors to Delos included a law
forbidding anybody from dying on the
island.
HOSPITAL NEWS MARCH 2014

If you want to get to Santorini (and you
really should want to see this beautiful island created when a volcano blew apart
the island of Thera between three and
four thousand years ago) you will need to
take a ferry to Naxos and then swap to a
Santorini bound boat. Once you get there
you will be faced with a wall of rock rising
from the ferry port with one switchback
road taking you to the top of the cliff for
your first of many heartbreakingly beautiful views. If you want a suggestion of where
to stay, the Grace Santorini in Imerovigli
(just a few miles north) has an entrancing
combination of luxury rooms, great service
and possibly the most perfect infinity pool
on the planet.
If you find the pace just right, then just
spend whatever time you have left wandering from island to island as you see fit. You
are now au fait with the ferries and can
look after yourselves.
If you want to up the excitement, keep
going south to the huge island of Crete.
If you are in a hurry to get there the Hellenic Seaways-Flying Cat can get you to
Heraklion in just 1 hour and 45 minutes.
Once there the island is big enough to offer pretty much anything you could wish
for. Between May and October the sixteen
kilometre long Samaria Gorge hike is famous for amazing views, wild goats and
the deep dark sections where the walls
rise vertically on either side of you. At the
end of the Gorge the quiet seaside village
of Aghia Roumelli can only be reached on
foot down the Gorge or by boat.
This is just one suggested route for a
little luxury island hopping, but with hundreds of inhabited islands the options are
legion. Wherever in the Greek islands you
choose to explore you will be rewarded
with new experiences and memories to last
H
a lifetime.■
Victoria Brenner is Director at The
Couture Travel Company. This article
appeared on www.aluxurytravelblog.
com and is reprinted with permission.

To see even more healthcare industry events,
please visit our website
www.hospitalnews.com/events
www.hospitalnews.com

PAIN CONTROL/COMPLEMENTARY HEALTH/HEALTH PROMOTION

Hospital spam
Continued from page 27

This, coupled with the fact that electronic communications within hospitals
are generally quite decentralized, will
make for a fairly detailed and onerous internal administrative compliance exercise,
particularly in larger facilities with research institutes and revenue-generating
groups and programs.

Beginning the CASL
Compliance Process
In order to comply with CASL, hospitals should start by:
1. Reviewing the organizationâ&#x20AC;&#x2122;s electronic messaging traffic; noting that
electronic messaging includes email, text,

Pain puzzle
Continued from page 22

What could then be the solution to the
pain puzzle? Evident too, all true solutions
start with ourselves.
If we want the Canadian medical system
to provide a true science based approach to
the treatment of pain, we have to start by
giving ourselves a better education in this
and other health related topics (becoming
responsible consumers), so we can then
question the clinical models that are failing to provide pain relief to so many of us.
Otherwise, like in physics, things will just
keep moving in the direction where forces
push them.
For practitioners, we now know enough
to start using a more refined diagnostic
and treatment model that favors interven-

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instant and social media messaging;
2. Determining which electronic messaging falls under CASLâ&#x20AC;&#x2122;s definition of CEM,
and identify situations where exemptions
or implied consent apply;
3. Conduct audits of the organizationâ&#x20AC;&#x2122;s
current electronic communications policies and practices with respect to CEM
and computer programs to ensure compliance with CASL;
4. Ensure that appropriate consent is in
place prior to July 1, 2014 for CEM; and
5. Put procedures in place to ensure ongoing compliance with CASL, including
form and content requirements, consent
tracking and the scrubbing of implied consents in accordance with CASLâ&#x20AC;&#x2122;s specified
time frames (as applicable).
Fortunately for hospital foundations,
CEM sent by charities with the primary
tions that modulate neurofunction at all
relevant levels. Interventions such as electroacupuncture and manual techniques,
complemented then with appropriate
interventions, including pharmaceutical
agents when they have a well-defined role
to play. If evidence-based medicine tells us
that only a minority of chronic pain is associated with inflammation, why are antiinflammatories one of the most prescribed
drugs to chronic pain patients?
Perhaps we can find an explanation from
the same â&#x20AC;&#x153;Pain in Canada fact sheetâ&#x20AC;? mentioned before: Veterinarians receive five
times more training in pain management
H
than people doctors. â&#x2013;
Dr. Alejandro Elorriaga Claraco,
Sports Medicine Specialist (Spain)
is Director, McMaster University
Contemporary Medical
Acupuncture Program.

objective of â&#x20AC;&#x2DC;raising fundsâ&#x20AC;&#x2122; for the charity have the benefit of an exemption from
CASL. However, even this exemption has
left some scratching their heads regarding electronic messaging sent by hospital
foundations for purposes other than fundraising given the broad definition of the
term â&#x20AC;&#x2DC;commercialâ&#x20AC;&#x2122;.

Grandfathering
and transition
One element of relief comes from
FAQâ&#x20AC;&#x2122;s published by the CRTC which state
that valid express consents obtained prior
to CASL coming into force will be grandfathered even if they didnâ&#x20AC;&#x2122;t meet CASLâ&#x20AC;&#x2122;s
identification and contact information
requirements, although opt-out consents
obtained under the federal privacy legislation will not be grandfathered. There
is also deemed implied consent for 36
months where there is an existing business
or non-business relationship.

Penalties
The maximum penalties for non-compliance with CASL are very steep: up to
$10 million for corporations, $1 million for
individuals. As well, a private right of action will allow consumers and businesses
to commence enforcement proceedings

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and recover damages (mercifully, the private right of action will not be in force
until July 1, 2017). Also important to
note is that officers, directors and agents
are liable, and can be subject to a private
right of action, if they directed, authorized
or participated in a contravention, unless
they can establish that they exercised due
diligence to prevent the commission of
the violation. The computer programming
provisions (the subject of a future article)
will not be in force until January 15, 2015.
With the exceptions noted above, the
rest of CASL will come into force on July
1, 2014. In light of the short timelines,
hospitals would be best served by working
together, and with the OHA and HIROC,
to make sense of this new legislation in the
health care context. Develop a standardized approach to CASL would help hospitals become compliant and reign in all of
those rogue hospital spammers.
*This article is a summary of a current
legal issue and is not meant as legal opinion or advice. Readers are cautioned not to
rely or act upon the information provided
in this article without seeking legal advice
H
relating to their specific circumstances. â&#x2013;